PROPOSAL FOR CITIZEN PARTICIPATION 1. Information on Contact: Name: Last Name: E-mail: Number of Phone: Municipality or province: 2. Participant 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. Profile: If you have selected an association or organization, please enter its name: 3. Proposed type of participation: 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. Description of the proposal: Please briefly explain how you would like to participate, what need you have identified, or what contribution you think you could make. 5. Areas of interest: To which area or topic of interest in health research does your proposal relate? 6. Availability to participate: —Please select an option—Yes, in person.Yes, via videoconference.Yes, by phone.Not at the moment. Would you be available to meet or provide more information about your proposal?: 7. Additional Documentation : Add an additional Documentation (optional): Select the file No file has been selected Allowed file type: PDF. || Maximum file size: 5MB. 8. Data Protection: Acceptance of the Privacy Policy (required). I authorize the sending of information about citizen participation activities (optional). NOTICE!: When you submit the form, a confirmation message will appear at the bottom of the page.
