RSFfeedbackAndy Coldron2024-07-11T15:38:32+00:00

RSF feedback form

This form is to be completed by the recipient of the award for the experience.

Thank you for taking the time to complete this form. Your feedback helps the Ruth Strauss Foundation understand the impact of the gift and aids in the development of our services and offerings. The information shared will be shared with the Ruth Strauss Foundation and used in reports, publications etc see the privacy notice from the Ruth Strauss Foundation.

The Ruth Strauss Foundation is delighted to be working with Something to Look Forward To so that together we can support families where a parent has incurable cancer to make memories together through special experiences. This project has been developed and funded by the Ruth Strauss Foundation and we are grateful to Something To Look Forward To who are hosting and administering this pilot.

About the referrer/nominator:
Prefix
Your Full Name (required)*
First Last
Your Email (required)*
Date of birth
DD slash MM slash YYYY
Who is in your family?
Who attended the experience?
What is your/your relative/friend’s cancer type?
What was your/your relative/friend’s year of primary diagnosis?*
DD slash MM slash YYYY
With the following statements about the experience, please score on a scale of 1-10 how much you agree with each one. The scale is from 1 ‘not at all’ to 10 ‘completely’
We enjoyed something we could do together as a family.*
(1 not at all, 10 completely)
1 2 3 4 5 6 7 8 9 10
We were able to make special memories together that we otherwise would not have.*
(1 not at all, 10 completely)
1 2 3 4 5 6 7 8 9 10
I/we have thought more about the support I/we may need to prepare our children for the future.*
(1 not at all, 10 completely)
1 2 3 4 5 6 7 8 9 10
How would you rate your experience of applying for, receiving, and using your experience from Something To Look Forward To? (please note the experience is administered by Something To Look Forward to on behalf of the Ruth Straus Foundation)*
(1 not at all, 10 completely)
1 2 3 4 5 6 7 8 9 10
Is there anything else you would like to tell us about the experience?
If not covered above, how much has the experience helped you and your family?
Can you tell us a little of what your children know about their parent’s incurable cancer diagnosis? Have you already shared the news with them or are you waiting too? Please add if the experience impacted these conversations at all.
The Ruth Strauss Foundation produces a range of communications resources to spread awareness and raise funds to support our mission. We like to share the experiences of real people who are using our services in our communications as it helps to demonstrate the difference our work is making. By completing this form, you give us permission to use your story in our communications for the next five years. Thank you for your help. Are there any identifying features you do NOT want included in our communications work? For example, your location or the age of your children.
Have you sought support from the Ruth Strauss Foundation since receiving this experience?*
- Yes
- No
- Already had
If answered 'No' and you would like support from the Ruth Strauss Foundation Family Support Service please visit click here and complete our short form. We will be in touch with you shortly. If you have already been in touch with us and would like to debrief or discuss anything further, please contact us at familysupport@ruthstraussfoundation.com
If you are willing to share a photograph from your family's experience please upload it here.
Drop files here or

Accepted file types: jpg, gif, jpeg, pdf, Max. file size: 24 MB.
Permission*
Please tick this box and print your name on this form to show you are happy to give permission for your story to be used by The Ruth Strauss Foundation for the purposes outlined above. Your story will not be republished or used for the charitable purposes you have permitted for any longer than 5 years from your original permission and will remain on our website and social media channels indefinitely. If you change your mind at any time, we will be happy to remove any current stories or references on your request (please note that web archives cannot be amended).
- (Tick to accept)
Please type your name*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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RSF feedback form

This form is to be completed by the recipient of the award for the experience.

About the referrer/nominator:

With the following statements about the experience, please score on a scale of 1-10 how much you agree with each one. The scale is from 1 ‘not at all’ to 10 ‘completely’