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Engagement Advisory Committee Application
Thank you so much for your interest in the Center for Patient Partnerships’ Engagement Advisory Committee.
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Name
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Email
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Phone
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Town/City
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Why are you interested in serving on the Advisory Committee? Would this service be healing for you?
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Your answer
What do you know about research to improve the health care system? No experience is required; it is just helpful for us to know.
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Your answer
Please review the job description in the link below. Do you have any questions about the opportunity? If yes, what are they: (Optional question)
View Job Description here:
http://www.patientpartnerships.org/research/advisory-committee/
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What might you bring to the Committee that would be unique?
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Your answer
Are you able to attend three, 2-hour meetings this year? The first will be in November, the second in January or February, and the third in May or June.
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Yes
No
Is there anything else you would like us to know?
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How did you learn about this opportunity?
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Email from CPP
Facebook
News item on CPP website
My advocate or a staff/volunteer at CPP
Saw a flyer
Someone told me about it and encouraged me to apply
Other:
Optional: Age range
18-35
36-49
50-69
70+
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Optional: Race/Ethnicity (select all that apply)
European American/White
African American/Black
Hispanic/Latino
Native American/Alaskan Native
Asian American
Middle Eastern American
Other:
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