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Yorkshire Cancer Community
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Cancer SMART Apply
Your Details
Which role are you applying for?
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- Select -
Digital Champion
Cancer Champion
First Name
*
Last Name
*
Email
*
Postcode
*
Phone Number
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Region
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Harrogate
Bradford
Calderdale
Kirklees
Leeds
Wakefield
Other
Facebook Account Name
*
We need this so we can invite you to our Facebook Digital Champions group.
Could you tell us why you would like to get involved with Cancer SMART?
Community Connector Consent
*
I agree to only share the Cancer SMART promotional messages supplied to me as part of my role as a Community Connector
Digital Champion Guidelines
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Guidelines for Digital Champions
I have reviewed and agree with the Digital Champion Guidelines
Privacy Policy
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Privacy Policy
I have reviewed and agree with the privacy policy
Demographic Information
Gender
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Female
Male
Trans
Non-binary
Intersex
Other
Prefer not to say
Not known/not asked
Age Band
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18-24
25-44
45-64
65-74
75-84
85+
Religious Belief
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Buddhist
Jewish
Christian
Muslim
Hindu
Sikh
Other Religion
None
Prefer not to say
Do you have a disability?
Yes
No
Note - The Equality Act 2010 considers a person to be disabled if they have a “mental or physical impairment that has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities”. You do not need to be registered disabled.
Disability
Mental health condition such as depression, dementia or schizophrenia
Physical impairment such as difficulty moving your arms or mobility issues
Long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsy
Wheelchair user
Learning disability or difficulty (such as Down’s syndrome or dyslexia) or cognitive impairment (such as autistic spectrum dis
Sensory impairment such as being blind or having a visual impairment
Sensory impairment such as being deaf or having a hearing impairment
Other (please state)
Prefer not to say
Details of Disability
Ethnic Group
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White: British / English / Scottish / Welsh / Northern Irish
White: Irish
White: Gypsy, Traveller or Irish Traveller
White: Roma
White: Any other White background (please describe)
Mixed / Mulitple ethnic groups: Black Caribbean and White
Mixed / Mulitple ethnic groups: Black African and White
Mixed / Mulitple ethnic groups: Asian and White
Mixed / Mulitple ethnic groups: Any other Mixed/Multiple ethnic groups background (please describe)
Asian / Asian British: Indian
Asian / Asian British: Pakistani
Asian / Asian British: Bangladeshi
Asian / Asian British: Chinese
Asian / Asian British: Any other Asian background (please describe)
Black / Black British: African
Black / Black British: Caribbean
Black / Black British: Any other Black / Black British background (please describe)
Other: Arab
Any other ethnic group
Prefer not to say
Not known
Other-please describe
Leave this field blank
