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Leukaemia UK Community Champions
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Become a Community Champion
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Your information is private and confidential and will not be shared with anyone and you can change your mind at any time. We will only contact you using these details in relation to Community Champions (unless you have opted into communications elsewhere). To see our privacy policy, visit
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Title
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Miss
Mr.
Mrs.
Ms.
Mx.
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Address
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Why do you want to become a Leukaemia UK Community Champion?
Is there a particular activity you are interested in doing? Some examples could include joining us in parliament to hand over a petition, writing to your MP, sharing your story, fundraising and raising awareness in your community, attending science conferences, sharing your opinion and experience with researchers, joining us at Leukaemia UK events.
What is your experience with leukaemia, and which type.
Would you be able to travel to other UK locations?
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Diversity Monitoring
Leukaemia UK wants to meet the aims and commitments set out in our Equality, Diversity, Inclusion and Belonging Policy. Completing this part of the form is voluntary. The information provided will be kept confidential. The information is going to be used to help us understand the diversity of the patients and relatives who are at the heart of everything we do.
Age
What’s your age?
Please select
19 or under
20-29
30-39
40-49
50-59
60-69
70+
Type of leukaemia
Please select
AML
APML
ALL
CLL
CML
Other
If 'other', please write which type here
Year of diagnosis with leukaemia:
Did you receive any of the following treatments?
Chemotherapy
Stem cell transplant
Stem cell transplant from cord blood
Trial drug
CAR-T therapy
Disability
Do you have a disability, impairment or health condition which affects your day-to-day activities?
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No
Prefer not to say
If yes, which of these statements apply to you? Select all that apply.
I have a physical disability
I have a medical condition
I have a mental health condition
Other or unknown
Neurodivergence
Do you identify as neurodivergent?
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No
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Please self describe here:
Are you now the same gender as you were at birth?
Is the gender you identify with the same as your sex recorded at birth?
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Socio Economic background
Socio economic background refers to a combination of factors that influence your social and economic status. This can include your family’s income, your parents’ level of education and the kind of job you (or your parent) have. Do you identify as coming from a Lower Socio Economic Background (SEB)?
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About leukaemia
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Understanding blood cancer
Signs and symptoms of leukaemia
Types of leukaemia
Open submenu
Acute lymphoblastic leukaemia (ALL)
Acute myeloid leukaemia (AML)
Chronic lymphocytic leukaemia (CLL)
Chronic myeloid leukaemia (CML)
Treatments
Clinical trials
Open submenu
IMPACT partnership
Support & resources
Research and advocacy
Open submenu
Research strategy
Open submenu
How we find and fund projects
Our funded research
Research funding opportunities
Open submenu
John Goldman Fellowships
John Goldman Fellowship Follow-up Fund
Project Grants
Patient Care Pioneer Award
Conference Support Fund
Mentoring
Campaign for change
Open submenu
Leukaemia UK Community Champions
Support us
Open submenu
Donate now
Open submenu
Donate in memory
Donate through your salary
Donate while you shop
Play the Leukaemia UK Lottery
Local events near you
Open submenu
Our fundraising events
Your fundraising events
In memory fundraising tributes
Create your own fundraising page
Who’s Cooking Dinner?
Corporate partnerships
Philanthropy
Leave a gift in your Will
About us
Open submenu
Our strategy
Our history
Patrons and Ambassadors
Who we work with
Work with us
Open submenu
Vacancies
Contact us
News and stories
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