Download Consumer Research Training 2015

Consumer Research Training 2015
Expression of Interest Form
Research consumers play an important role in the research process by ensuring that
research is conducted with the community it is intended to benefit. Cancer Council NSW’s
Consumer Research Training is suitable for people with an interest in cancer research and a
willingness to work directly with cancer researchers to provide the consumer perspective to
their research projects. The training equips consumers to assist researchers who seek
consumer involvement in their research projects. It is expected that after completing the
training, consumers will make themselves available as a consumer representative to
appropriate research projects.
Cancer survivors and their carers, family and friends are welcome to participate in this
training. If you are from outside Sydney and able to stay with family or friends during the
training, we will ask you to do so; but aside from this, there will be no costs incurred by
participants.
Personal and contact details
Name
Postal address
Phone
Mobile
Email
Date of birth
Are you of Aboriginal or
Torres Strait Islander
origin? (optional)
Do you identify as a
member of a cultural or
ethnic group? If so, which
group? (optional)
1
Cancer experience
Please tell us about your personal experience with cancer.
Example: My mother was diagnosed with lung cancer in 2011, and received chemotherapy
and radiotherapy.
Your experience
Type of cancer, when diagnosed, treatment undertaken
Diagnosed with cancer
yourself
Carer of cancer patient
Family member diagnosed
Friend diagnosed
No experience with cancer
Other (please describe)
Training and consumer experience
Have you previously been or are you currently part of a cancer consumer organisation?
YES
NO
If yes, please describe:
Have you previously been trained as a consumer representative or consumer advocate?
YES
NO
If yes, please describe who provided the training, what it equipped you to do, and when it
was held:
Are you planning to attend this training on behalf of a research organisation or cancer
charity?
YES
NO
If yes, please include the name of this organisation/charity and your contact person there:
2
Criteria
Please outline how your skills and experiences meet each of the criteria in the blank spaces
below (please provide a maximum of 200 words per criterion).
Experience
Essential: Experience with
cancer and/or experience
representing the interests of
consumers.
Desirable: Good links with
consumer networks,
associations, societies, or
groups.
Desirable: Up to date with
current consumer issues.
Special skills
Essential: Willing to learn about
medical and research language.
Specialist knowledge
Essential: Ability to ‘think like a
consumer’ and consider the
questions that patients may ask.
Desirable: Previous experience
working as a consumer
representative.
Personal qualities
Essential: Good communicator
(both written and verbal).
Desirable: Ability to give
feedback to the researcher to
help develop their research
program.
3
Your interest in this role
What is it that interests you
about working directly with
researchers as a consumer
representative?
Other life experiences
Please provide any other
information you believe is
relevant to making you a good
fit for the role of consumer
representative on research
projects
Other questions
Would you like to receive research newsletters from Cancer Council NSW? (We will not
send you requests for donations)
YES
NO
How did you hear about this training?
4
Availability
Are you available to participate in the training workshop on the 20th
November 2015 or add to a list for 2016 training?
YES
/
NO
Are you willing to work directly with cancer researchers by acting as a
consumer representative on their research projects?
YES
/
NO
YES
/
NO
Your details will be given to Cancer Voices NSW who provide a ‘matching’
service which links researchers and consumer representatives. If you do not
wish to be listed on the Cancer Voices NSW database, you may opt out of this
expectation at the training. Please see Privacy Statement on page 6 of this
document.
The training will be held in Woolloomooloo, Sydney, NSW. If you are
coming from outside of Sydney, will you be able to stay with friends or
family?
There are no costs to participants, so if you need accommodation and flights,
we will cover the costs. However, as we have a limited budget, if you are able to
stay with friends or family it will mean that we can afford to have a larger number
of people attend the training.
Please return completed Expression of Interest forms to:
John Williams
Research Governance Officer
PO Box 572, KINGS CROSS NSW 1340
153 Dowling Street, Woolloomooloo NSW 2011
Tel:
(02) 9334 1993
Email: [email protected]
We look forward to hearing from you - thank you very much for your time and interest.
5
Privacy Statement
The Cancer Council NSW is collecting the information in this form for the purpose of
registering you for this event, program or campaign. If you do not provide this information,
you may not be able to participate.
Cancer Council may use your details to send you information about Cancer Council’s and
third parties’ products, services, events, fundraising or any other activities which we consider
may be of interest to you. You may unsubscribe by contacting us.
We may disclose your information to our contractors, third party service providers,
volunteers and agents that may assist Cancer Council. We may also disclose your
information to like-minded organisations to contact you with information that may be of
interest to you, such as Cancer Voices NSW, to enable them to contact you about
opportunities for you to act as a consumer representative on cancer research projects.
Cancer Council will handle your personal information in accordance with the Privacy Act
1988 (Cth) and its Privacy Policy (which is available on our website or which can be provided
to you on request). The Privacy Policy also explains how you can contact us to access and
correct your personal information, or make a complaint about a breach of the Australian
Privacy Principles.
For more information, please contact us via telephone on (02) 9334 1993 or via email at
[email protected].
6