Request for consumer & community involvement in research First name * Last name * Email * Which panel/s are you applying to? * Rural Health Consumer Panel MindCare Collective Program Advisory Group (PAG) ME/CFS & Long Covid ONJCRI Patient Advocacy Program ReGEN Think Tank Working title of your project * About the opportunity * Brief overview of what is involved in the role/s e.g. meeting attendance / reviewing applications / research design and protocols. Include timeframe, duration and expected hours. About the role and its responsibilities * Brief overview of what is involved in the role/s e.g. meeting attendance / reviewing applications / research design and protocols. Include timeframe, duration and expected hours. About your organisation * Please tell us about your organisation, for example if you’re a non-profit, a university, research organisation etc. Who do you need to hear from? * Brief statement about what is needed e.g. demographics, representation, experience How will your consumers / community members be supported? * What will contributors gain from undertaking this role? Provide details of any support offered e.g. payment, mentoring, training, in-kind compensation. Acknowledgement of consumer panel * Please indicate your agreement to insert the following statement in project communication e.g., reports, publications, presentations. We acknowledge the involvement of panel members from La Trobe University’s (insert panel name) I agree Privacy and confidentiality * The privacy of our members is very important. Please indicate your agreement that personal data will be protected and individual panel members will not be named or identified in any public context unless they have specifically requested it. I agree Evaluation of consumer / community involvement * Your feedback helps us to evaluate the impact of consumer involvement in research. Please indicate your agreement to being contacted for monitoring the outcomes of consumer panel involvement in your project. I agree Are you a La Trobe researcher? * If you are a La Trobe researcher seeking funding, please respond to the remaining questions below. Yes No Additional Information for La Trobe researchers Are you applying for funding for your grant research proposal? Yes No About the grant Please specify the funding opportunity and any key deadlines (Max. 100 words). Payment information The Research Office can provide funding up to $750 per application for consumer or community involvement in developing the grant. This is only available to La Trobe researchers. If you wish to involve members of more than one panel, please specify the distribution of costs. If you will be drawing upon other sources of funding for consumer involvement, please specify, or explain why no other sources are available to you. Privacy Statement All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information to organise visits and, if required, prepare Letters of Invitation that list the institution representatives wishing to visit the University. In accordance with privacy laws, personal information about you contained in your enquiry will not be used for any other purpose or disclosed to any person who is not part of organising your visit without your permission. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting La Trobe's Educational Partnerships team via email at Edpartnerships.international@latrobe.edu.au. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/ Validation
