Consumer Research Training 2016

Expression of Interest Form /

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’sConsumer in Research training is suitable for people with an interest in cancer research and a willingness to work directly withcancer researchers toprovidethe consumer perspectiveto 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.

Consumer Review Paneltraining is suitable for people who have completed the Consumer Research Training (including those who will attend the 2016 training day),have an interest in cancer research, and a willingness to help Cancer Council NSW make decisions about which research projects should be funded.

Cancer patients, survivors,carers, or close family member or friend of someone diagnosed with cancer are welcome to participate in the training. Cancer Council NSW covers all costs for attending the training, including travel and accommodation if required. However,as we have a limited budget, if you are from outside Sydney and able to stay with family or friends during the training, we kindly request you do so.

Please indicate which training course you are interested in attending (you may select both):

Consumer in Research training: YESNO
Consumer Review Panel training:YESNO

If you wish to attend the Consumer Review Panel training, please indicate what year you attended the Consumer in Research training (you will be eligible to participate in the Panel training after completion of the Consumer in Research training in 2016 or in any year prior):

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)

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?

YESNO

If yes, please describe:

Have you previously been trained as a consumer representative or consumer advocate?

YESNO

If yes, please describe who providedthe training, what itequipped you to do, and when it was held:

Are you planning to attend this training on behalf of a research organisation or cancer charity?

YESNO

If yes, please include the name of this organisation/charity and your contact person there:

Criteria

Please outline (in the blank spaces below)how your skills and experiences meet each of the criteria (please providea 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 researchertohelp develop theirresearch program.
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)

YESNO

How did you hear about this training?

Availability

Are you available on Monday, 5 September for Consumer in Research training?
If no, would you like to be advised of Consumer in Research training in 2017?
For graduates of Consumer in Research training (including 2016 participants):
Are you are available on Tuesday 6 September for Consumer Review Panel training?
If no, would you like to beadvised of Consumer Review Panel training in 2018? (Please note, this course is offered every two years.) / YES / NO
YES / NO
YES / NO
YES / NO
Are you willing to work directly withcancer researchers by acting as a consumer representative on their research projects?
Your details will be given to Cancer Voices NSW who provides a ‘matching’ service that 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 7 of this document. / YES / NO
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 thatwe can afford to have a larger number of people attend the training. / YES / NO

Please return completed Expression of Interest forms to:

Research Grants Management Team

Cancer Research Division

Cancer Council NSW

PO Box 572, KINGS CROSS NSW 1340

Email:

We look forward to hearing from you - thank you very much for your time and interest.

Privacy Statement

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 NSW 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 email at .