S.T.E.P. Application S.T.E.P. Application Name* First Last Email PhoneDate of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employment/School Name*Employment/School StatusFull TimePart TimeRetiredRelationship to Person Diagnosed with Cancer*SelfSpouse/PartnerParentChildSiblingDate of Last Active Treatment?Note from Doctor Drop files here or Select files Accepted file types: jpg, png, pdf, docx, Max. file size: 400 MB. Cancer Survivors’ please upload a note from your doctor stating that you are cleared for physical activity and please include any and all limitations. All others please upload proof of active cancer treatment or treatment in the last 2 years of cancer patient selected above.Do You Play Sports?*YesNoThis field is hidden when viewing the formList Sports PlayedHow Did You Hear About this Program?*Social MediaRadioFriend/FamilyEvent/Another CharityDoctor/Cancer CenterThe Scott Experiment LLCWhat are Your Fitness Goals?*