Angel Reassignment Form...

Full Name:
Postal Address:
City, State, Postal Code:
Country:

Telephone No:
E-mail address:
Alternate E-mail address, if any:

Age:
Gender:
Your last patient/seniors full name:

Please indicate How often did you send to your previous patient/senior...

I sent at least once a week for the most part.

I sent every ten days or so.

I sent about once or twice a month.

Chemo and Card Angels - Did you continue sending at least once a week until you were notified by the administration that your assignment was over?

Yes, I did.

No, I tapered off once I knew his/her chemotherapy was over.

For Angels who did not send weekly If you sent less than once a week, can you please assure us that you will be able to send at least once a week to your next assignment? Please consider this carefully. If you found sending once a week difficult with your last recipient, perhaps Chemo Angels is not the right volunteering venue for you.

Yes, I feel certain that I will be able to keep the "at least once a week" commitment with any future assignments.

If you do not feel that you will be able to commit to sending at least once a week, we thank you for your honesty. Please click on the link below to resign from the Chemo Angels organization.

Resign from program...

Tell us about your next assignment For my next assignment I'd like to be a

Chemo Angel Card Angel Senior Angel

If you are a cancer survivor, please indicate your type of cancer .

On my next assignment I can adopt a buddy from a foreign country. Yes. No.

State your preference, if any - buddy gender, age, etc

State type of buddy you do not wish to be assigned to, if any - gender, age, etc

If religion/spirituality is important in your life, please describe

Do you have children? Grandkids you are close to? If so, please give age/gender

Tell us about your hobbies, interests, etc.

Thank you! Although we try to reassign previous Angels as soon as possible, it might take a few weeks. Thank you for your patience!