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
*
If you are a student, please include the name and email of your supervisor
Department/Institution
*
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)
*
Advocacy/Public Policy
Community Support
CF Healthcare
CF Research
Fundraising
Communications
Transplant
Other (please specify)
Start date:
*
-
Month
-
Day
Year
Date
End date:
*
-
Month
-
Day
Year
Date
What is the time frame/length of participant involvement or commitment?
*
Provide a brief overview of your project and its objectives
*
What is your plan for data management? (i.e., collecting and storing the information you receive from Elevate members, 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, Cystic Fibrosis 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 or incentives?
No
Yes (please specify how much, how often and payment method)
Attachments - please attach any helpful documents to support your request.
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Follow-up
To help our Elevate members see the difference they’re making, we’ll reach out once a year to ask for a brief update on your project.
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