Proposal for Citizen Participation Proposal for Citizen Participation 1. Datos de contacto Name: Last Name: E-mail: Number of Phone: Municipality or province: 2. Perfil de la persona participante Profile: —Please select an option—Client or patient.Family member or caregiver.Citizen (male or female).Representative of a patient advocacy group.Representative of a social or civic organization.Another profile. If you have selected an association or organization, please enter its name: 3. Tipo de participación propuesta How would you like to participate? Propose a research need or priority.Participate in the design or development of a project.Help review documents or materials.Participate in meetings with research groups.Participate in conferences, workshops, or educational activities.Participate in the dissemination of research findings.Help with the monitoring or evaluation of Projects.To provide the perspective of patients, family members, or the general public.Suggest another way to participate.Help improve the Clinical Research Unit (CRU) based on specific needs. 4. Descripción de la propuesta Please briefly explain how you would like to participate, what need you have identified, or what contribution you think you could make. Descripción de la propuesta: 5. Ámbito de interés To which area or topic of interest in health research does your proposal relate? 6. Disponibilidad para participar ¿Estaría disponible para mantener una reunión o ampliar la información sobre su propuesta? —Please select an option—Yes, in person.Yes, via videoconference.Yes, by phone.Not at the moment. 7. Documentación adicional Add an additional Documentation (optional): Tipo de archivo permitido: PDF. Tamaño máximo: 5 MB. 8. Protección de datos Acepto la política de privacidad (obligatorio). I authorize the sending of information about citizen participation activities (optional). ¡AVISO!: cuando envíe el formulario, aparecerá un mensaje de confirmación en la parte inferior de la página.
