The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Cancer Connection Survey 2022

Welcome to Cancer Connections 2021! By completing this surveyYou will have registered to participate in some or all webinar sessions. Because this program is funded through a grant from the Centers for Disease and Control, we have reporting requirements regarding participant profiles (category of participant, age, type of cancer, geographic location, race/ethnicity, etc.). Please complete and submit this short anonymous survey so that we can meet this reporting requirement. It will take you less than 3 minutes to complete. All data will be aggregated (combined) and no individual’s profile will be reported. Thank you!

Name:

* must provide value

E-Mail Address

* must provide value

Please tell us about you: (check all that apply)

I am a cancer survivor

I have been diagnosed with metastatic cancer (cancer thriver)

I am the co-survivor (family member, friend, supporter of a survivor or thriver)

I am a healthcare provider

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1. Have you participated in Cancer Connections in the past? (Check all that apply)

Yes, 2018

Yes, 2019

Yes, 2020

Yes, 2021

Unsure

Prefer not to answer

2. What is your current age?

3. What is your gender?

4. In what state do you live?

In what county do you live?

5. If you are a survivor or thriver, what type of cancer was your diagnosis? If you have been diagnosed with multiple types of cancer, what type of cancer was your most recent diagnosis?

Bladder

Bone

Brain

Breast

Cervical (cervix)

Colon (intestine)

Endometrial (cancer of the uterus)

Esophageal (esophagus)

Head and neck

Heart

Hodgkin's Lymphoma (Hodgkin's disease)

Larynx

Leukemia (blood)

Liver

Lung

Melanoma

Neuroblastoma

Non-Hodgkin's Lymphoma

Oral (mouth)

Ovarian (ovary)

Pancreatic (pancreas)

Pharyngeal (throat)

Prostate cancer

Rectal (rectum)

Renal (kidney)

Skin, not melanoma

Stomach

Testicular (testicles)

Thyroid

Other

Don't know / Not sure

Prefer not to answer

If selected "other", please specify

6. How did you hear about the 2022 Cancer Connections webinar series?

My doctor/clinic

Friend

Received an e-mail

Received a letter

Facebook

Newspaper/Newsletter

Announced in a meeting

Twitter

Flyer

My church/faith community

The Active Age

Catholic Advance

Other:________________

If selected "other", please specify

7. How do you plan to participate in Cancer Connections? (Check all that apply)

Use my computer at home

Use my computer at work

Join by phone

Participate with a group

Join by phone only

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8. What is your Race/Ethnicity?

White, Not Hispanic

White, of Hispanic origin

Black not Hispanic

Black, of Hispanic origin

Asian

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

Multiple Races

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.