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100 characters
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Administrator Name
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Different than Organization
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Cambodia
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Canada
Cape Verde
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Chad
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China
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Cuba
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Congo ( DRC )
Denmark
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Administrator Postal Code
Other Contact Information
Name and title of person responsible for integrating FitSteps for Life into your organization (Answer "Unknown" if this person isn't in place yet)
25 characters
Direct Phone
Extension
Organization Structure
Number of oncologists on staff
Numbers only - 10 characters
Number of oncology patients served per year
Numbers only - 10 characters
Geographic area served
100 characters
Mission | Alignment
Provide a brief, relevant history of your organization
500 characters
Summarize your goals, mission, and vision
500 characters
Explain how your mission and vision align with Cancer Foundation For Life's mission to enhance the quality of life and survival for individuals living with cancer and its vision to incorporate individually tailored and supervised exercise programs as a standard of care in oncology practice?
2500 characters
Describe your interest, if any, in using FitSteps for Life as a resource for research
1100 characters
Space | Equipment
Do you have an existing facility that could accommodate FitSteps for Life?
Yes
No
Describe the size of the space allocated to providing FitSteps for Life (minimum 600 sq. ft.)
500 characters
List any existing equipment in your facility you would specifically dedicate to providing FitSteps for Life
500 characters
What space do you have available to accommodate FitSteps for Life (minimum 600 sq. ft.)
500 characters
Describe potential opportunity, if any, to expand FitSteps for Life to additional locations within your organization (i.e. wellness centers or satellite locations,) including the geographic location of those facilities
500 characters
List the hours during the week when you would be willing to provide FitSteps for Life (i.e. Monday-Friday, 8am-3pm)
50 characters
Staff Requirements
The FitSteps for Life program must be administered by individuals degreed in Exercise Science. ACSM CET certification is preferred. Do any current staff meet these requirements?
Yes
No
List how many individuals and their qualifications
100 characters
Are you willing to fulfill these staffing requirements if awarded funds?
Yes
No
Successful Partnership
If selected to receive funding to incorporate FitSteps for Life into your organization, describe your ability to independently sustain FitSteps for Life for a minimum of 5 years
2500 characters
What marketing resources are utilized in your organization and how would you incorporate FitSteps for Life into your marketing strategy for program sustainability?
2500 characters
What other ideas for partnership do you have?
1500 characters
Attachments
Upload FitSteps for Life project budget
Upload letter signed by oncologists acknowledging the benefit of exercise treatment and their commitment to support FitSteps for Life
Upload most recent Form 990
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