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, complete the following form a minimum of 4 weeks before 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
*
If you are a student, please include your supervisor's name and email here
Department & Organization
*
Email
*
example@example.com
Phone Number
-
Country Code
-
Area Code
Phone Number
Project Information
Please provide specifics about your project below.
What is the title of your project? (Provide English and French name if applicable, e.g., University of Province CF Study / Université de Province Étude sur la fk)
*
Project Name
Which of the following topic(s) best describe(s) your project? (Select all that apply)
*
CF Advocacy/Public Policy
CF Community Support
CF Healthcare
CF Research (below, attach current Research Ethics Board approval & participants draft email written in lay language)
CF Fundraising
CF Communications
CF Transplant
Other (please specify)
Project start date:
*
-
Month
-
Day
Year
Date
Project end date:
*
-
Month
-
Day
Year
Date
What is the time frame/length of participant involvement or commitment (e.g., 1 hour, 4 hours over 6 months)?
*
Does this project have Research Ethics Board (REB) approval?
Please Select
Yes (please attach a copy of the REB approval)
No (REB approval is pending)
No (REB approval is not needed)
Provide a brief overview of your project and its objectives
*
What is your plan for data management? (i.e., how will you collect and store information from Elevate members)
Please provide the url of the project or survey, if applicable
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 (please write this in lay language for a grade 8 audience)?
*
How do you plan on sharing feedback with participants, Cystic Fibrosis Canada, and the wider community?
*
How many people do you hope to engage in this project?
*
Age criteria? Select all that apply. (Note: Elevate members are 18+ 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
Participant 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
Other (please specify)
Race/ethnicity criteria? Select all that apply.
All
Asian
Black
Caucasian
First Nations People
Hispanic
South Asian
Other (please specify)
Please list any other specific demographics for participants. (i.e., modulators, transplant, etc.)
In what language will you be communicating with participants?
*
English
French
Both English and French
Is there honoraria or incentives?
No
Yes (please specify how much, how often and payment method)
Attachments. For research projects, please attach a copy of your current Research Ethics Board approval. Also attach a draft email for participants written in lay language for a grade 8 audience.
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Follow-up
To help our Elevate members know the difference they’re making, we will email you annually in November to request an update about your project and any results.
I agree to provide an annual update about my project and any results
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