In order to reach as many people as possible, we limit nominations to those in active treatment (chemo, radiation, mastectomy/lumpectomy) or within 6 months of active treatment for Breast Cancer. Those who have moved into survivorship (cancer-free) do not qualify for a gift from KWF

KWF is committed to positively serving ALL women living with breast cancer.  Diversity, equity, and inclusion are core to our strategy.  For this reason, it is helpful to analyze in aggregate the impact of our work.  Proving the information below is completely voluntary, and will not impact the decision-making process of giving gifts of FUN in any way.

Your Medical Information

Please submit a screenshot of your diagnostic report from your "MyChart" or online medical portal.
In the screenshot, we will need to see the following items:

• Your first and last name
• The Name of your treatment center
• Your diagnosis
• The date of your diagnosis
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A how-to for Windows users can be found here.
A how-to for Mac users can be found here.

For example, Ductal Carcinoma, Triple Negative, Inflammatory, Lobular Carcinoma, Male Breast Cancer, etc.

Medical Team/Primary Hospital (required):

Current treatment plan or next steps:

Please share a bit about your journey (required):

Please tell us about your family or support system (required):

How many people are in your immediate family? (required):

Rate your emotional / mental well-being today:

How are you doing?

Help us get to know you and design your gift of fun

Please list your hobbies (required):

When it comes to fun we want you to think outside the box. Share some of your bucket list ideas and biggest wishes. Keep in mind we have done Gifts of Fun ranging from dinner dates, to skydiving, VIP experiences at the zoo to meet and greets with sports teams, tickets to the theatre, to private art classes. These gifts are all thanks to our donors and partners.

What type of FUN are you interested in?  (To select multiple options, press 'Ctrl' while making your selection.) Required.

Have you traveled in the last 6 months or do you have any upcoming travel plans? (required)

Please list your favorite food or restaurants:

Is there anything else you want us to know about you?

At the Karen Wellington Foundation, we deeply value your privacy. The information you provide on this form will be used solely for reviewing your nomination and finding the perfect Gift of Fun for you. The personal medical information will not be shared with anyone outside of the KWF foundation.That said, whenever possible, we love to deliver these gifts in person, often accompanied by our dedicated KWF staff members, volunteers and possibly members of your supportive community.

We understand that everyone’s journey is unique, and some may wish to keep their diagnosis more private. If you have any privacy concerns or specific preferences regarding how your gift is delivered or the public/private nature of your diagnosis, please let us know below. We’re excited to celebrate you with a Gift of Fun soon!

Please upload 2 photos of yourself. (required)

Showcase You: Choose a photo that reflects who you are and what you love. This could be a solo picture or one with loved ones, but make sure you’re the main focus.
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‍Quality Counts: Please ensure the photo is clear and well-lit so we can see your smiling face. Avoid using filters or overly edited images.
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‍Keep It Family-Friendly: Photos should be appropriate for all audiences.