Share Your Story | Emily Whitehead Foundation

Thank you for your interest in sharing your story with the Emily Whitehead Foundation! We would be honored to have your family contribute to our mission to spread awareness of pediatric cancer and the innovative treatments striving for a cure.

Story Submission Form

Upon completing this form, you will be contacted with additional information and be asked to complete a story/photo release.

Name*
First Last
Email*
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Link to website or Facebook Page about your journey
Child's Name (First and Last)*
Age*
Have you/your child received CAR T-cell therapy, or another form of immunotherapy treatment?*
- Yes
- No
- Currently in CAR-T treatment
- Currently enrolled in a CAR-T clinical trial
- Other immunotherapy
When did you/your child receive CAR T-cell therapy?
Date(s) of infusion
Hospital treated at:
How did you find out about CAR T-cell therapy?
If other, which treatment are you/your child currently receiving?
Check that which applies:*
- I am writing my/my child's story
- I would like to have my/my child’s story written for me
Additional comments or questions:
Email
This field is for validation purposes and should be left unchanged.

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