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Thank you for your interest in CCPH’s Consultancy Network. The CCPH Network is a resource utilized to support and augment our national footprint. Consultants engaged through the Network support a myriad of projects. Consultants generally work alongside CCPH staff and provide very specific content expertise, all of which are centered on enhancing the capacity of both academic and community leaders to engage in authentic partnerships yielding transformative experiences and outcomes. CCPH consultants must demonstrate a shared commitment to our Principles of Partnership, social justice and health equity. Our consultants usually have backgrounds in academia or prior experience as patient advocates, community experts, academic researchers and key members of diverse organizations and agencies.

CCPH is currently revamping our Consultancy Network to meet the expanding needs and attention to community engagement. We would like to know more about your specific expertise, skills and knowledge. We are looking for subject matter experts and individuals with specific skill sets, so please be explicit about your professional background and areas of specialization.

This survey will take about 10-15 minutes to complete. Please select the responses that best reflect your current capacity and interest to do the activities mentioned in each question.

If you have questions or concerns please address your inquiries to ccph.consultant.ab@gmail.com.

Thank you!

Please provide your name and contact information:

Name

Address

Phone Number

Email Address

Affiliated organization

Current role with organization

In 2-4 sentences, please summarize your interests, experience, and/or skills. Please list any related professional licenses or certifications.

What was your role in the research partnerships you have worked with in in the past? Check all that apply.

Led or co-led a research study (e.g. as a Principal Investigator or Co-Investigator)
Partnered directly in research activities (e.g., assisted the project team in recruiting study participants, conducting trainings, moderating focus groups, collecting data)
Served as a research stakeholder to provide guidance on the conceptualization, implementation, and/or dissemination of research
Other

What type of community engaged activities have you participated in? Check all that apply.

During the COVID19 pandemic what communities and populations have you partnered with, provided services or resources to? Choose all that apply.

Have you been involved in developing grant submissions for any of the following funding sources? Check all that apply.

Are you responding to the call for interns? (STUDENTS ONLY)

Yes
No