Do you need advice or would you like to collaborate with us? Tell us about your project and we will get back to you as soon as possible. "*" indicates required fields To begin, tell us what is the purpose of your request:*ChooseStrategies to support the recruitment of patient partnersTraining on patient partnership (Partnership School)Research or evaluation (Partnership Lab)Deployment of a patient partnership strategyPresentation or participation at a conferenceOther (scientific collaboration, student, etc.)Strategies to support the recruitment of patient partners Fields marked with an * are required. Please note that the CEPPP does not offer placement services for patient partners. However, we can assist you in your process of recruiting patient partners, both in the development of recruitment tools and in the interview process.Training on Patient Partnership Fields marked with an * are requiredResearch or Evaluation Fields marked with an * are required. Note about research conducted in Quebec If your research is primarily conducted in Quebec, first check whether it fits within the priorities of Quebec’s SPOR SUPPORT Unit. If so, we invite you to fill out the form on their website. >> Check the SPOR SUPPORT Unit eligibility criteria hereDeployment of a Patient Partnership Strategy Fields marked with an asterisk are required.Presentation, Conference or Participation at an Event Fields marked with an asterisk are required.Other Request (Scientific Collaboration, Student Opportunities, Etc.) Fields marked with an asterisk are required.ABOUT YOUName of your organization*Your first name*Your last name*Your email address* Your phone numberYour country*Your countryAfghanistanAfrique du SudAlbanieAlgérieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArménieArubaAustralieAutricheAzerbaïdjanBahamasBahreïnBangladeshBelarusBelgiqueBelizeBermudesBhoutanBolivieBonaire, Saint-Eustache et SabaBosnie-HerzégovineBotswanaBrunei DarussalamBrésilBulgarieBurkina FasoBurundiBéninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCorée du NordCorée du SudCosta RicaCroatieCubaCuraçaoCôte d’IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Swaziland)FidjiFinlandeFranceGabonGambieGhanaGibraltarGrenadeGroenlandGrèceGuadeloupeGuamGuatemalaGuernseyGuinéeGuinée équatorialeGuinée-BissauGuyaneGuyaneGéorgieHaïtiHondurasHong KongHongrieIndeIndonésieIrakIranIrlandeIslandeIsraëlItalieJamaïqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKoweïtLa BarbadeLa RéunionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMacédoineMadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicronésieMoldavieMonacoMongolieMontserratMonténégroMozambiqueMyanmarNamibieNauruNicaraguaNigerNigériaNiuéNorvègeNouvelle-CalédonieNouvelle-ZélandeNépalOmanOugandaOuzbékistanPakistanPalauPanamaPapouasie-Nouvelle-GuinéeParaguayPays-BasPhilippinesPolognePolynésie françaisePorto RicoPortugalPérouQatarRoumanieRoyaume-UniRussieRwandaRépublique DominicaineRépublique centrafricaineRépublique du CongoRépublique démocratique du CongoRépublique démocratique populaire du LaosRépublique tchèqueSahara occidentalSaint BarthélemySaint MartinSaint Pierre et MiquelonSaint-Christophe-et-NevisSaint-MarinSaint-SiègeSaint-Vincent-et-les GrenadinesSainte HélèneSainte-LucieSalvadorSamoaSamoa américainesSao Tomé et PrincipeSerbieSeychellesSierra LeoneSingapourSint MaartenSlovaquieSlovénieSomalieSoudanSoudan du SudSri LankaSuisseSurinameSuèdeSyrieSénégalTadjikistanTanzanieTaïwanTchadTerres Australes FrançaisesTerritoire britannique de l’océan IndienThaïlandeTimor orientalTogoTokelauTongaTrinité et TobagoTunisieTurkménistanTurquieTuvaluUkraineUruguayVanuatuVenezuelaVietnamWallis et FutunaYémenZambieZimbabweÉgypteÉmirats arabes unisÉquateurÉrythréeÉtat palestinienÉtats-UnisÉthiopieÎle BouvetÎle ChristmasÎle MauriceÎle NorfolkÎle de Géorgie du SudÎle de ManÎles CaymanÎles CocosÎles CookÎles FalklandÎles FéroéÎles Heard et McDonaldÎles Mariannes du NordÎles MarshallÎles PitcairnÎles SalomonÎles Turques et CaïquesÎles Vierges américainesÎles Vierges britanniquesÎles de Svalbard et Jan MayenÎles mineures américainesÎles ÅlandYour province or territory (if in Canada)QuebecAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonABOUT YOUR PROJECTWhat is the field of your research project?*What is the field of your research project?*ChoosePartnership in researchPartnership in careOtherWhat are your expectations towards the CEPPP?*ChooseSupportCollaborationFull supportWhat is the date of your event?* DD slash MM slash YYYY Please, specify the location (city, address)*What is the general theme of your event?*Is there a specific topic for which you would like a CEPPP member to contribute?*What are your objectives?*Quels sont vos attentes ou objectifs?*If available, enter the link to the website or program of your eventSummary of your project*What is your assessment of financial resources available?What are your objectives regarding the engagement of patient partners in your project?*Desired start date for the mandate* DD slash MM slash YYYY Approximate start date* DD slash MM slash YYYY Desired end date for the mandate* DD slash MM slash YYYY Approximate end date* DD slash MM slash YYYY ABOUT YOUR TRAINING NEEDSIn which domain do you work?*Which training modules have you already taken?* None 101 201 301 Other(s) What are your training needs and objectives?*This field is hidden when viewing the formWould you like to subscribe to the CEPPP distribution list (e.g., information watch, newsletters, new projects, etc.)?* Yes No Send me a copy by email? Send me a copy by email? NameThis field is for validation purposes and should be left unchanged. Δ
