The Colon Club
2018 On the Rise Featured Survivor Application
Before applying, please review the following responsibilities of being a Survivor featured in On the Rise (formerly Colondar 2.0). It is a bit like being selected to be Miss America - for the following year after being selected you are expected to raise awareness, fundraise, advocate and be the voice for change and a CURE (See below)!
What are my responsibilities as an On the Rise Featured Survivor?
As a Featured Survivor in On the Rise you will featured in The Colon Club’s 2018 annual, colorectal cancer awareness magazine, baring your scar(s) and sharing your journey. On the Rise includes articles about the obstacles that you, as young adults living with CRC, face such as infertility, farting, sex, genetics, body image, ostomy and clinical trials. Knowledge is power and On the Rise is changing the perception of colorectal cancer and how we support, educate, raise awareness and provide hope.
What are my goals as an On The Rise Featured Survivor?
-Raise AWARENESS, FUNDRAISE, ADVOCATE and be the voice of change, prevention, aggressive treatment options and ultimately a CURE!
What do I have to do?
The role of an On the Rise Featured Survivor is to:
-Educate others about the signs & symptoms of colorectal cancer http://colonclub.com/signs-symptoms-of-colon-cancer/.
-Fundraise using your Colon Club fundraising page in order to "pay it forward" so other survivors can attend "Colon Camp" the following year - just as prior Featured Survivors have done for you.
-Attend and promote local awareness/fundraising events when possible.
-Like, share, re-tweet Colon Club and other CRC community news and events on social media.
-Promote On the Rise and The Colon Club (TCC) website/organization.
-Act as community liaisons for TCC to the public by sharing TCC/On the Rise news on social media, speaking at local events, fundraising for TCC and selling/distributing On the Rise.
-Regularly communicate with TCC about your fundraising and awareness activities.
-Actively contribute to TCC by participating in discussions, sharing experiences, etc. on social media and with various news outlets (Ex. newspapers, blogs, TV news, radio).
-Provide support to current and previous Featured Survivors by attending events, promoting events online, sharing online fundraising efforts, etc.
The Colon Club’s Commitment to You - We are here for you!
-Cover the cost of your flight, room and food and drinks while attending Colon Camp. (You are responsible for miscellaneous fees such as: baggage, parking and food during travel).
-Provide you with materials for events, as long as we have a 4-week notice.
-Provide a fundraising page on our website as well as information and support to help you to fundraise.
-Continue to provide opportunities to learn and improve your advocacy skills.
What is my time commitment as an On The Rise Featured Survivor?
-Attend Colon Camp at the Five Star Retreat July 19 - 23, 2017.
-Volunteer! Throughout the year there are always ways to get more involved. We may have additional requests and needs with TCC awareness initiatives and planning.
-One-Year fundraising effort.
-Attend Call on Congress (ConC) in March 2018 to launch On the Rise (that you are featured in) – you will be responsible for your flight and miscellaneous expenses (luggage, parking, alcohol, food outside of ConC).
If you accept this "mission" then we are happy for you to proceed to the following application:
Complete the following application to be considered for the 2018 issue of On The Rise. Again, the dates of "Colon Camp" are July 19 - 23, 2017, at the Five Star Retreat, just outside Nashville, TN. You must be available for the entire time of the shoot (no late arrivals or early departures.) If you are selected, the following expenses are paid: flight, lodging and all meals while you are at Colon Camp.
If you are selected, spouses, partners, friends or other family members are not able to attend. This is an opportunity for YOU, as a selected survivor to meet others that are like you, experiencing and going through similar journeys and we want you to soak up every moment that you will have with your fellow colon brothers and sisters in order to have the full Rock Star treatment of having your hair, makeup and wardrobe done for your special time on set!
Please follow the directions carefully and be sure to attach the correct files to the correct questions below or your application may be delayed being reviewed for selection. When writing your story, be sure to share your entire CRC journey. Remember, the selection committee doesn't know who you are and your bio helps you stand out applicants, their dx, journey's and treatments are reviewed!
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Phone Number (cell)
Phone Number (home)
You must be available for the entire time of the shoot (no late arrivals or early departures.) Are you available July 19 - 23?
Hometown(s) (where you have lived for any significant length of time?)
Where do you work?
What is your occupation?
Please list any sports-related or healthy living activities that you are involved in (separate your answers with a comma) ?
Date of Diagnosis:
What were your symptoms, if any?
How were you diagnosed?
Age at diagnosis:
Stage at Diagnosis (please use Roman Numerals. ex: Stage I, Stage II, Stage III, Stage IV):
Did you have Laparoscopic surgery?
Type/Date of Surgery(ies):
Treatment Regimen(s) (specific chemo/radiation):
Where were you treated?
Have you been involved in a clinical trial?
If yes, please identify:
Did you take steps to preserve your fertility?
Are you currently cancer free?
Did you/do you have a temporary or permanent ostomy?
If you have/had a temporary or permanent ostomy, are you willing to show it?
Are you comfortable being photographed while showing your scar?
Have you ever had genetic testing?
If yes, what did it show?
Do you have a family history of colorectal cancer/polyps/other digestive disorders or diseases (found either before or after your diagnosis)?
If yes, who had cancer and at what age(s)?
Do you know anyone else with colorectal cancer, especially anyone around your age?
What is the most important thing you learned from having cancer?
Are you involved with any other colorectal cancer organizations (check all that apply)?
Colon Cancer Alliance (CCA) + Chris4Life Colon Cancer Foundation
Are you involved in any other general cancer organization (check all that apply)?
American Cancer Society
Critical Mass (LiveStrong)
In one sentence, describe what you want people to know about colorectal cancer?
On the Rise Magazine (formerly Colondar 2.0)
How did you hear about On the Rise?
Other CRC organization
Past or Present Colondar/On the Rise Model
Why do you want to be a part of On the Rise?
What are your goals for your participation in On the Rise?
What do you personally hope to get out of the photo shoot weekend?
Do you have any concerns about becoming a featured survivor for On the Rise?
If selected as a Featured Survivor in On The Rise, you are expected to fundraise in order to "pay it forward" so other survivors can attend "Colon Camp" the following year - just as prior Featured Survivors have done for you. Are you willing to fundraise?
If no, what prohibits you from fundraising?
Have you ever told your story in a public way before?
If yes, describe how you did this:
Is your story on the Internet?
If yes, where:
Have you ever done any media/interviews?
Do you feel comfortable doing any of the following (check all that apply)?
Participating in CRC advocacy
Interviews for print media
All of the above
If you are selected as a featured survivor, you will be expected to help raise money so this project can continue. Are you willing to do this?
Have you previously applied to be featured in the Colondar or Colondar 2.0?
If previously applied, please list what year(s):
Please attach your long bio, written by you, in story format.
Keep bio to 2-3 pages in length.
Files must be in PDF format:
Attach a picture of your scar (regardless of how big or small). Files must be Jpeg, GIF or PDF format:
Attach a picture of yourself. Please make sure the picture is clear and in Jpeg format:
Picture does not have to be a professional picture. Can be a head or full body shot.
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