Community Based Research Advisory Committee Application

Required fields are marked with asterisks (*)

Contact information

Full Name*

Email Address*

Phone Number *

City or town in Ontario where you currently live:*

About you and your community connection

Is there a community, identity or lived experience you would like to help represent on the committee? *

What community or health-related topics are you particularly interested in exploring through this committee? *

Please describe: *

Your experience

Have you served on a public, patient, community or academic advisory committee before? *

Yes No

Do you have experience working with community groups, charities or not-for-profit organizations? *

Yes No

Do you currently work, or have you previously worked, in the health care system or health research? *

Yes No

Your interest in the role

What do you hope to gain from being a member of committee? *

What strengths, skills or perspectives would you bring to the committee? *

Logistics and participation

Do you require any accessibility supports to fully participate in meetings? *

Yes No

Please describe:

How do you prefer to attend committee meetings (select all that apply)? *

In person Virtual/online Either is fine

Osler Research Institute for Health Innovation newsletter and updates

Would you like to join our Research newsletter mailing list? *

Yes No

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