Share Your Story What you’ve faced is hard, traumatic. But it’s also inspirational. Believe it or not, sharing what you’ve been through might just be the encouragement someone else needs to face their fight today. View Champion Stories Ready to share your story? Every day, people turn to Fight CRC looking for stories of hope: stories from other patients, caregivers, and loved ones in the fight against colorectal cancer. If you’re ready to share your story on the Fight CRC website, please complete the form below. You can request an update to your story at any time; in fact, we welcome it!Note: Your story will not appear on our site immediately. Please allow up to a week for us to process your submission. Thank you for sharing your story with our community: It’s an impactful reminder that no one fights alone. "*" indicates required fields Name* First Last Email* Mobile PhoneState / Province / Region* Country Your Ethnicity (select all that apply) American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Pacific Islander White Caucasian Prefer not to answer Other What is your connection to colorectal cancer (CRC)?* Patient/Survivor Caregiver Family Member of Patient NOT Blood Relative Family Member of Patient Blood Relative Friend of Patient Medical Professional Other What stage were you/your loved one at the time of diagnosis?* Previvor Rectal - Stage I Rectal - Stage II Rectal - Stage III Rectal - Stage IV Colon - Stage I Colon - Stage II Colon - Stage III Colon - Stage IV N/A How old were you/your loved one at the time of diagnosis? What type of screening discovered the cancer? (select all that apply):* Fecal Occult Blood Test (FOBT) Fecal Immunochemical Test (FIT) FIT-DNA (Cologuard®) Colonoscopy Other (please explain) other screening that discovered cancer Tell us about the diagnosis. When did it happen, where were you when you got the news, and was anyone with you? How did you feel?*What symptoms were happening prior to the diagnosis? (Select all that apply) Rectal bleeding or blood in stool Ongoing change in bowel habits Narrow stools Stomach cramps/bloating/fullness Unexplained, sudden weight loss Anemia/low iron Fatigue Unable to have a bowel movement (bowel obstruction) or constipation No symptoms Other (please explain) other symptoms prior to diagnosis What type of treatment(s) did you receive? Chemotherapy Targeted therapy/immunotherapy Surgery Radiation Other other types of treatment Did you get tested for biomarkers (tumor testing)? Yes No Unsure If known, what are you/your loved one’s biomarkers? Are any genetic syndromes involved in your case? Lynch syndrome Familial adenomatous polyposis (FAP) Peutz-Jeghers syndrome (PJS) MUTYH-associated polyposis (MAP) Cystic fibrosis (CF) Other other genetic syndromes If you or your loved one have or had an ostomy, what type? (select all that apply) Colostomy Ileostomy Permanent Temporary Reversal Surgery Did you experience any of these side effects because of treatment? Pain LARS Neuropathy Skin rashes (skin toxicity, chemo rash) Increased anxiety, stress, or mental health issues/illness If you/your loved one participated in a clinical trial, can you tell us more? If you/your loved one have not participated in a clinical trial, why not? Did/do you/your loved one have easy access to affordable health care where you live? Yes No Did/do you/your loved one have any problems with insurance coverage? Yes No Have you/your loved one faced any recurrences and/or secondary cancer(s)?* Yes No type of recurrence or secondary cancer What advice do you have for someone who might be afraid to seek medical advice or colorectal cancer screening?*What words of wisdom do you have for other relentless champions? Share some words of encouragement or advice you received that helped you.*What should all members of Congress know about colorectal cancer patients’ needs?*HiddenIf you had a blank check to fund colorectal cancer research, how would you spend it? What would you fund?*What tools, information, or resources have you found most helpful for navigating a diagnosis?Please enter your social media handles if you'd like us to share them as part of your bio.Please upload a recent photo(s) of yourself. You can upload up to 3 photos. (Bonus points for a #StrongArmSelfie pic!).*Use an image that is at least 300 pixels wide and 300 pixels tall. If you are comfortable sharing, please upload a photo of yourself during treatment. Drop files here or Select files Accepted file types: jpg, png, jpeg, Max. file size: 50 MB, Max. files: 3. Declaration: By submitting this application, I confirm that all the information provided is accurate and complete to the best of my knowledge. If awarded the grant, I agree to use the funds exclusively for the stated event purpose and provide a post-event report on its outcomes and financial expenditure. Date MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. Δ