Elevate Project Intake

ELEVATE PROJECT REQUEST FORM

Elevate is CF Canada's virtual volunteer initiative for people impacted by cystic fibrosis that is intended to provide opportunities for feedback and responses from Elevate members to help guide cystic fibrosis research, care, support and programs. To make a project request to Elevate, complete the following form approximately 3-4 weeks in advance of your project start date. Questions can be directed to elevate@cysticfibrosis.ca
Your Information

Please provide your information below.
Name

First Name Last Name
Position/Title
Department/Institution
Email
example@example.com
Phone Number
Please enter a valid phone number.
Project Information

Please provide specifics about your project below.
What is the official name of your project? (Provide English and French name if applicable, i.e. Research Network Survey/Questionnaire pour le réseau de recherche)
Project Name
Which of the following topic(s) best describe(s) your project? (Select all that apply)

Advocacy/Public Policy Community Support CF Healthcare CF Research Fundraising Communications Transplant Other (please specify)
Study start date (when will the initiative be in market?):

Month Day Year
Date
Study end date:

Month Day Year
Date
Will you be taking a phased approach to your research?

No Yes (please specify)
What is the timeframe/length of participant involvement/commitment?
Provide an overview of your project and briefly describe your projects objectives
What is your plan for data management? (Collecting, storing, sharing the information you receive via Elevate, etc.)
Which of the following methodologies will you be using to conduct your project? (Select all that apply)

Survey Poll Focus group Committee Document review Interview Other (please specify)
How will your project positively impact the cystic fibrosis community?
How do you plan on sharing feedback with participants, CF Canada, and the wider community?
How many people in the community do you hope to engage in this project?
Age criteria? Select all that apply.

Between 13 and 17 years old Between 18 and 29 years old Between 30 and 39 years old Between 40 and 49 years old 50 years or older All
Gender criteria? Select all that apply.

Male Female Other (please specify)
Location criteria? Select all that apply.

Canada-wide Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon
Connection(s) to CF criteria? (Select all that apply)

Person living with CF Parent of a child who has/had CF Child of a person who has/had CF Extended family member of a person who has/had CF Sibling of a person who has/had CF Spouse/Partner of a person who has/had CF Other caregiver of a person who has/had CF CF Clinician CF Researcher CF Canada staff No CF connection Other (please specify)
Race/ethnicity criteria? (Select all that apply)

Asian Black Caucasian First Nations People Hispanic South Asian All Other (please specify)
Do you have other specific demographics? (I.e., modulators, transplant, etc.)
In what language will you be communicating with participants?

English French Both English and French
Will there be honoraria/incentives?

No Yes (please specify how much, how often and payment method)
Please describe your communication plan for this study, including your promotion and recruitment plans (Specify if you will be recruiting through any other channels outside of Elevate)
Attachments - please attach any documents you may wish to share to support your request.

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ELEVATE PROJECT REQUEST FORM

Your Information

Project Information