Please fill out the form below to provide us the necessary information to help you find a CARRA member to meet your needs. You will receive a response in approximately 3 business days.
If you have any questions about filling out this form, please contact CARRA at ncicarra@mail.nih.gov or (301) 594-3194. Thank you.
Your Contact Information
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Your Name:
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Your Email:
(Example: username@mail.nih.gov)
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Phone:
(Example: 5-1212 or 301-555-1212)
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Fax:
(Example: 5-1212 or 301-555-1212)
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Division:
(Example: DCCPS, Office of Tobacco Use)
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Activity Description
Please specify how many actual CARRA member names
you will need to participate in your activity.
CARRA recommends that you include 1 advocate for every
10 non-advocates participating.
*Remember that CARRA program staff will provide you with
several CARRA member names for each advocate actually needed.
Please give a brief description of your activity that
includes the following:
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Title of your Activity
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Date(s)
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Location (is travel required?)*
* Please remember that travel must be paid for by the
requesting department.
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A general description of CARRA members duties
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Overall time commitment for a CARRA member
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Other types of people participating in the activity/meeting
(i.e. scientists, researchers, physicians, other government
employees, media, etc.)
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Resources you can provide to support CARRA members (i.e.
background materials, travel expenses, etc.)
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What are you looking for in a CARRA member?
All CARRA members are either a(n):
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Cancer survivor
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First-degree family member or life partner
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Individual with more than 3 years of substantial,
demonstrated involvement in cancer-related activities
In addition, all CARRA members have met
the following requirements:
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Interest in learning about cancer, familiarity
with cancer and science-related issues, or formal training
in these areas
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Membership in a cancer-related group or
organization
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Leadership qualities
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Writing skills and ability to make oral
presentations
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Ability to work as both a team player
and a self-starter
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Ability to represent the perspective of
a group
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Ability to evaluate and understand cancer
issues beyond their own cancer experience
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Interest in extending their personal knowledge
about cancer and cancer issues
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Ability to speak, read, write, and understand
English
Please describe any additional skills or
experience that you would like a CARRA member to have for
your activity. Examples include the following:
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Race, ethnicity, gender, geographic location,
or other demographic characteristics
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Cancer site-specific experience
We will make every effort to find an advocate
that best suits your needs.
Are there any conflicts of interest?
Please list any potential conflicts of
interest.
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