Researcher Opportunity Submission Form

Contact Name *
Contact Name
Contact Phone
Contact Phone
Submission of Interest Deadline *
Submission of Interest Deadline
Please select the deadline for participants to submit their expressions of interest in this opportunity.
Research project, quality improvement team, advisory council, etc.
Patient/Family Advisor, Patient/Family Co-Leader, Patient/Family Surveyor, etc.
What organization is the opportunity offered through?
What will the patient/family advisor be asked to do?
What knowledge, experience or skills would the ideal advisor have?
What are the responsibilities of the advisor?
How frequent will the PFA be engaged, for how many hours, where?
How long with the PFA be engaged in the project, committee, etc.
Explain how the staff will support the PFA.
Explain what orientation will be provided.
Supports available to participate *
Check those which apply, rates do not need to be given at this time.
Please enter a description of additional supports available, if you selected 'other' in the above question.