Community Advocate Bio

Community Advocate Bio
Cancer Care Services is in the process of identifying potential members for a disparities and health equity coalition. Your input would be greatly appreciated.
Name

First Name Last Name
Email
example@example.com
Cell Number
Have you been impacted by cancer? (Select all that apply):

Yes, as a Caregiver Yes, as a cancer Patient Yes, as a Survivor No
List any skills or abilities you believe you can contribute to the community group:
List any connection to organizations or places within the community where members gather or where we may be able to gather information from community members:
Have you ever been involved in research? If so, what type? What was your role? Was that research relevant to this community?:
List any other groups within this community that you are part of:
Do you have any experience with the following?(Select all that apply):

Coordinating small meetings Coordinating large meetings Meeting facilitation Taking notes Recruiting skills Making outreach phone calls Door-to-door canvassing Interviewing skills Distributing a survey or test Facilitating a focus group Doing online research Collecting data Developing surveys Breaking down data Writing reports Editing reports Photography Videography Designing/digital skills Coordinating small events Coordinating large events Teaching Developing presentations Presenting to small groups Presenting to committees Presenting to large groups Providing comments to policymakers
Specific to the purpose of this community group, what do you see as your greatest contributions:
List any personal, social or political connections that you have within the community that may be an asset for this community group:
Should be Empty: