The American Cancer Society: Survey - High School Graduates

High School Graduates

Are you a graduating high school student that participates in Relay For Life? If you want to continue to participate in Relay For Life at your college, please complete the following fields so we can put you in touch with the American Cancer Society staff that works with the university you will attend. Thank you!

*1.

First Name

*2.

Last Name

*3.

Email

*4.

Please list the name of the Relay in which you participate

*5.

In what city is your Relay?

*6.

In what state is your Relay?

*7.

What is your position in your current Relay (Team Captain, Committee Member, Team Member, Survivor, etc.)?

*8.

What University are you planning on attending?

*9.

What year are you graduating high school?

10.

Please provide a cell phone or primary phone number that can be used to reach you

11.

Please check all that apply

	I am a cancer survivor
	I am/have been a caregiver