Nominate Your Hero! We want to celebrate your Gold Ribbon Hero and share their childhood cancer story with our community. If you would like to nominate your child or a special someone who has made a difference in your child's life, please complete the Gold Ribbon Hero nomination form below.

Help us recognize the brave warriors, raise awareness about childhood cancer, lend a helping hand, and give our kids the strength and courage to persevere each and every day.

*Please help us keep our data clean by double checking your spelling & punctuation*

Submitter Information

Prefix

First Name

Last Name

Phone Number (Mobile)

Relationship to Nominated Child

Street Address

City

State

Zip

Country

Would you like to join our email list?

YesNo

Desired Communication Type

ACCO Advocacy Efforts ONLY Member

As an "Advocacy Efforts ONLY" member you will only receive information regarding changes to current childhood cancer legislation, upcoming childhood cancer legislation and advocacy efforts initiated by ACCO.

ACCO Awareness Opportunities ONLY Member

As an "Awareness Opportunities ONLY" member you will only receive information regarding ACCO's awareness t-shirt campaigns (ICCD and Go Gold) as well as awareness events in your local community hosted by ACCO.

ACCO Full Supporter

As an "ACCO Full Supporter" you will receive information about Childhood Cancer advocacy efforts, local events in your community and ACCO awareness opportunities both locally and countrywide.

Nominee's Information

First Name

Last Name

Has the nominee's name ever been submitted for any of our awareness campaigns?

YesNo, but I would like more infoNot sure

Email our Public Relations Coordinator, Blair Scroggs at bscroggs@americanchildhoodcancer.org for more information!

Nominee's Address Same as Submitter's?

YesNo

Street Address

City

State

Zip

Country

Name of the school where the Nominee teaches

Grade level the Nominee teaches

Subject the Nominee teaches

Name of the hospital/facility where the Nominee works

Number of years as a Child Life Specialist

Unit/Department the Nominee works in

Name of the hospital/facility where the Nominee works

Number of years as a Social Worker

Unit/Department the Nominee works in

Name of the hospital/facility where the Nominee works

Number of years as a Nurse

Unit/Department the Nominee works in

Nominee's Current Status

Nominee's Date of Birth

MM/DD/YYYY

Date of Diagnosis

MM/DD/YYYY

Date of NED

MM/DD/YYYY

Relapse Location

Cancer Type

Current Cancer Stage

Clinical Trial Phase

Secondary Cancer Type (if applicable)

Cancer Subtype

ALL Subtype

AML Subtype

Bone Tumor Subtype

Brain/Spinal Cord Tumor Subtype

CML Subtype

CMML Subtype

Ewing's Sarcoma Subtypes

Germ Cell Tumor Subtypes

Hepatoblastoma Subtypes

Kidney Cancer Subtype

Lung Tumor Subtype

Neuroblastoma Subtype

NHL Subtype

Other Tumor Type

Ovarian Cancer Subtype

Pancreatic Cancer Subtype

Retinoblastoma Subtype

Rhabdomyosarcoma Subtype

Sarcoma Subtype

Skin Cancer Subtype

Soft Tissue Sarcoma Subtype

Testicular Cancer Subtype

Thyroid Cancer Subtype

Secondary Cancer Subtype

ALL Subtype

AML Subtype

Bone Tumor Subtype

Brain/Spinal Cord Tumor Subtype

CML Subtype

CMML Subtype

Ewing's Sarcoma Subtypes

Germ Cell Tumor Subtypes

Hepatoblastoma Subtypes

Kidney Cancer Subtype

Lung Tumor Subtype

Neuroblastoma Subtype

NHL Subtype

Other Tumor Type

Ovarian Cancer Subtype

Pancreatic Cancer Subtype

Retinoblastoma Subtype

Rhabdomyosarcoma Subtype

Sarcoma Subtype

Skin Cancer Subtype

Soft Tissue Sarcoma Subtype

Testicular Cancer Subtype

Thyroid Cancer Subtype

Nominee's Hospital Information

Hospital where the nominee is receiving treatment

Hospital City

Hospital State

Name of Nominee's Social Worker/Child Life Specialist

Social Worker/Child Life Specialist's Email Address

Check the box below to tell us why this childhood cancer advocate is a Gold Ribbon Hero

Nominee's Story and Social Media

Share their cancer journey with us!

Tell us why this person is a Gold Ribbon Hero!

Nominee's Website:

Nominee's Facebook Page:

Nominee's Caring Bridge Page:

Nominee's Fundraising Page:

Other social media pages:

Additional Questions

What led to the diagnosis? For example: what symptoms or activities led you to seek medical help?

Date child was diagnosed?

Initial impressions when the child was diagnosed

Walk us through the day the child was diagnosed

What is the treatment plan? Chemo? Radiation? Give us an idea of what your child is going through.

Has your child had any surgeries? Will they be facing any surgeries? If so, please explain.

What have been the obstacles and triumphs during this journey?

Tell us something special about your child! (not cancer related!) What do they like to do for fun? We like to add what the child likes to do or potentially what they are interested in.

What is the current status of your child?

ACCO Free Resources

Did you know ACCO offers free resources for kids and families?

YesNo

If you're interested in our free resources, fill out our form HERE and go to our website for additional information on resources ACCO provides.

Check the box below to share photos of this Gold Ribbon Hero Nominee

Share Photos!

Submit a maximum of five (5) high-quality photos of the nominee for us to share on our Social Media! If you have videos, please add them too!

Photo 1

Photo 2

Photo 3

Photo 4

Photo 5

If you experience any issues sending over information or uploading photos/videos, please reach out to Blair Scroggs, bscroggs@americanchildhoodcancer.org