Cancer Buddy Connection Program

Do you want to talk to someone-

who has been through a cancer experience similar to your own?

Do you want to talk to someone-

but don’t want to worry your family members or friends?

A cancer diagnosis is a life-altering event and although each individual may have a unique outcome, the journey itself is often marked by uncertainty and challenge. In an effort to provide compassion, support and guidance to ease this journey, the CancerConnects Cancer Buddy Connection Program pairs newly-diagnosed cancer patients with “mentors” who have been through a similar diagnosis, as well as through the process of treatment and recovery. Our trained volunteers provide a broad range of insight and support (from a single phone call to lasting friendships) and help patients take advantage of resources available to them right here in our Central and Northern New York community.

PDF icon Application - Are you interested in being a mentor to new cancer patients?
PDF icon Application - Would you like the support of a cancer survivor?

Online Versions of These Forms

Mentor Application
Participation Form

"We all have friends, family, doctors, therapists in our lives that we can talk to, but unless they’ve lived through a cancer diagnosis themselves, they can’t fully understand what that diagnosis means...”

H. Cleary
CancerConnects Mentor

"First as a mentee, and now as a mentor, I have developed some very special bonds.  Where once I was able to hear it, I am now able to say, ‘I know what you are going through’… and really mean it.”

C. Gilchriest
CancerConnects Mentor

Mentor Application Form

First Name
Last Name
Please include the number of girls or boys and their age(s) at the time of diagnosis
First Name
Last Name
Treatment (If applicable)
First Name
Last Name
First Name
Last Name
Please list if you have received chemotherapy, radiation, hormonal, or other treatment. Along with the treatment, please tell us the date and type.
Please type your name as a confirmation to the above information.
Just making sure you are a human.

Participant Registration Form

First Name
Last Name
Please include the number of girls or boys and their age(s) at the time of diagnosis
First Name
Last Name
Treatment (If applicable)
First Name
Last Name
First Name
Last Name
Please list if you have received chemotherapy, radiation, hormonal, or other treatment. Along with the treatment, please tell us the date and type.
Please type your name as a confirmation to the above information.
Participant Consent Form

Participant Consent

  • I understand as a participant in this program I will be matched with a mentor who is a cancer survivor and similar to me in terms of the cancer diagnosis when possible. My mentor will have participated in an orientation-training program.
  • I understand that all CancerConnects Volunteer Mentors will keep in extreme confidence any information provided by myself and /or family membersat all times. This statement covers medical status, personal or family life, and opinions expressed by myself and/or family member. Limitations to this policy are the following: suspected child abuse and neglect, dangerousness to self/others, cognitive impairment resulting in an inability to adequately care for myself.
  • I understand the mentor is a layperson who is not trained to give medical or psychological advice.
  • I understand the contacts with my mentor will be either over the telephone or face-to-face in a public meeting place.
  • I agree to have my name, diagnosis, treatment, and telephone number given to the mentor in order for him/her to contact me.
  • I understand my participation in this program is completely voluntary.
  • I understand my physician will be informed that a mentor has been assigned.

Please type your name below as an agreement to these terms.

Please type your name as an agreement to these terms.
Just making sure you are a human.
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