Volunteer Application

Contact Information

Special Skills/Interests, Certifications or Qualifications (select all that apply)


Special Considerations

Do you have any limitations, physical or otherwise, that we should know about so that we can make your volunteer experience a good one?

Cancer Connections

Have you had any personal experiences with cancer?

Background Screening

Please be aware that answering Yes to one or more of the questions below will not automatically disqualify you from volunteering. If you answer Yes to any question(s) below, the Director of Outreach will set up a time to discuss the circumstances with you further.
1. Have you ever been convicted of a crime or do you have any pending charges against you? *
2. Have you ever been charged with or do you have any pending charges for child abuse or neglect? *


How did you hear about volunteering with Cancer Support Community Central Indiana?

Person to Notify in Case of Emergency

Please Note your General Availability

 Morning (8:30am-12:00pm)Afternoon (12:00pm-5:00pm)Evening (5:00pm-8:00pm)
For more information, please contact Rachel Kegerreis at 317-257-1505 or rachel@cancersupportindy.org.