NFAC Research, Innovation Subcommittee Application

NFAC Research, Innovation Subcommittee Application

Thank you for your interest in joining the Neuroscience Family Advisory Council's Research, Innovation and Discovery Subcommittee to help bring the voice and perspective of our patients and families to our research initiatives and projects.

We appreciate your time in completing this application and look forward to connecting with you!

APPLICANT INFORMATION

First Name*

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Middle Name

Last Name*

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Street

City

State

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Mobile Number

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Ethnicity or Race (optional)

Our goal is to have an ethnically and racially diverse committee

INTEREST & BACKGROUND

How did you hear about the NFAC Research Subcommitee?*

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What is your connection to Boston Children's Hospital?

I have a child who is or was a BCH Neurology patient

I was a BCH Neurology patient when I was a child

Other (Please specify)

Other (please specify)

Do you have any experience participating in a research study?

Yes

Not sure

Do you have any experience conducting a research study?

Yes

Not sure

If applicable, please explain your research experience(s) indicated above.

Qualities and experience

What qualities and experience do you feel you could bring to the NFAC Research Subcommittee? (For example: other committees, boards or volunteer work, parent perspective etc.)?

COMMITMENT OUTLINE

Time Commitment

Subcommittee members serve for a minimum of 3 years
Meetings occur 4 times per year (1 hour per meeting)
Feedback sessions with researchers occur 2-3 times per year (1 hour per meeting)

Responsibilities

Consistent, active and respectful contributions to discussions

I can commit to the requirements above.*

Send me a copy of my responses

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