APIAHF Programs

Chronic Diseases Program

Asian & Pacific Islander National Cancer Survivors Network (APINCSN)

Asian and Pacific Islander American Health Forum's (APIAHF) Asian American and Pacific Islander (AAPI) Cancer Survivors Capacity Building Project aims to address the need for a comprehensive continuum of care through collaboration, training, capacity building activities and tools to incorporate survivorship and support services into both mainstream and AAPI cancer programs across the United States. Through the facilitation of a network of cancer support groups and programs, the Asian and Pacific Islander National Cancer Survivors Network (APINCSN) will connect and coordinate AAPI serving cancer organizations and survivors to similar counterparts. APINCSN is comprised of cancer survivors, caregivers, health care providers, researchers, community organizations and cancer programs that are concerned about the issue of cancer in the AAPI community. Our goal with your help is to provide peer-to-peer education, demystify cancer detection, increase screening and treatment, and provide support to cancer patients and survivors, as well as improve cancer awareness, early detection and survivorship for AAPI communities.

APIAHF would like to collaborate with you to reach and involve the AAPI community and develop AAPI specific cancer support groups across the nation. Become a member of the APINCSN to receive updates from our listserv and future newsletters on cancer research and treatment, and connect with other survivors and caregivers and/or submit your organization's information to our Cancer Resource Guide that will connect cancer patients and survivors to relevant healthcare and educational resources.

Please submit the form below via this website,
or mail, fax, or email the completed form to:

APIAHF, 450 Sutter Street, Suite 600 , San Francisco , CA 94108

Fax: (415) 954-9999 Email: rbautista@apiahf.org

Download PDF Form - Download Word Document

Contact Information
Organization
Department/Project (if applicable)
Organization Address
City, County, State, Zip code
Contact Person
Title or Position
Telephone
Fax
Email Address
Organization's Web Address

Would You Like to become a member and/or be listed in the Resource Directory?

Yes, please list me ONLY in the APINCSN Resource Directory and any future online directories.

Yes, please list me ONLY as a member .

Yes, please list me BOTH as a member and in the APINCSN Resource Directory .

Prospective members: Tell Us More About You Resource Guide Members: What ethnicities do your organization serve?
Ethnicity: (check all that apply) : Asian Groups
Asian Indian	Filipino	Korean	Sri Lankan
Bangladeshi	Hmong	Laotian	Taiwanese
Burmese	Indonesian	Malaysian	Thai
Cambodian	Iu Mien	Nepalese	Vietnamese
Chinese except Taiwanese	Japanese	Pakistani
Other Asian (please specify):

Native Hawaiian/Other Pacific Islander Groups (NHOPI)
Chuukese	Korean	Palauan	Tahitian
Native Hawaiian	Marshallese	Fijian	Tongan
Guamanian/Chamorro	Pohnpeian	Samoan	Yapese
Other NHOPI (please specify):

Prospective members: What languages do you speak? Resource Guide Members: What languages are served by your organization? (please check all that apply)
Afghani	Farsi	Japanese	Marshallese	Tongan
Bengali	Hakka	Kapangpangan	Mien	Urdu
Cambodian	Hawaiian	Khmer	Samoan	Vietnamese
Cantonese	Hindi	Korean	Tagalog	Visayan
Chamorro	Hmong	Lao	Thai
English	Ilokano	Mandarin	Toisan
Other (please specify):

Resource Guide Members: Which geographic areas do you serve? (please check all that apply)
National	Jurisdiction
State
Other (Such as: Region, more than one county, etc.):

Prospective members: What Cancer Services did you use? (please check all that apply) Resource Guide Members: What type of cancer control activities does you organization currently provide or participate in? (Please check all that apply)
Prevention/Education	Policy Advocacy	Health Education
Legal Services	Research	Support Groups
Clinical Trials	Detection	Language/Translation
Wellness	Referral Services	Disease Management
Counseling	Treatment Options	Seminars/Workshops
Alternative Therapy	Hospice Services	Financial Advice
Grief Counseling	Primary Health Care	Patient Navigation
Other (please specify):

Resource Guide Members:
Is there a fee to access your organizations services?

Yes

Prospective members: If you are a cancer survivor or a family/friend of someone with cancer, please specify type of cancer. Resource Guide Members: What Site/Cancer(s) are served by organization? (please check all that apply)
Breast	Prostate	Liver	Leukemia/Lymphoma
Colorectal	Lung	All Sites/Cancer	Childhood Cancers
Other (Please Specify):

What activities would you you like to participate in?

Please check all that apply

Participate in focus groups, advisory boards, or committees	Speak with newly diagnosed Asian and/or Pacific Islander cancer patients
Public speaking on cancer	Receive training on working with the media
Obtain information on cancer issues	Receive training on the legislative process
Call, visit, or write to policy makers	Receive training on public speaking

APIAHF Programs

Chronic Diseases Program

Asian & Pacific Islander National Cancer Survivors Network (APINCSN)

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