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Simmons Comprehensive Cancer Center - Volunteer Research Advocate Application

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Thank you for your interest in serving as a Research Advocate! The Research Advocacy Program at Simmons Comprehensive Cancer Center will use community input to ensure that our research is relevant to the needs of the DFW area. In contrast to Patient Advocates who provide input on how to improve delivery of cancer care in clinics and hospitals, Research Advocates focus on initiatives that improve clinical research. This research shapes our understanding of why cancer develops and helps evaluate new treatments.

It is important that Research Advocates reflect the diverse populations living in DFW. Simmons is recruiting: patients who have completed treatment, caregivers, and community members with a vested interest in cancer research to be trained and serve as Research Advocates.

Training will be provided and no prior research experience is needed. Orientation is scheduled for Friday, November 12th from 11am – 1pm and Wednesday, November 17th from 3pm – 5pm via ZOOM. Monthly follow-up training sessions will take place monthly through August 2022.

As an advocate, you can help by:

Reviewing and providing feedback on research proposals, grants, and abstracts
Serving on a panel or as part of a committee to develop a new research study
Improving accrual to trial participation by identifying barriers to participation
Writing letters of support for cancer-related research
Sharing scientific discoveries with the community via lay-friendly presentations

Applications are due by October 15th, 2021. For questions about the application or program, please contact: OfficeofCOEE@utsouthwestern.edu.

Please tell us about yourself in the application below.

First Name

* must provide value

Last Name

* must provide value

Street Address

* must provide value

City

* must provide value

State

* must provide value

Zip Code

* must provide value

Cell Phone

* must provide value

Email Address

* must provide value

Occupation/Employer

* must provide value

Gender (check all that apply)

Male

Female

Transgender

Non-binary

Prefer not to share

What are your pronouns?

She, her

He, him

They, them, their

Prefer not to share

Other

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Other pronoun (please specify):

Are you 18 years or older?

Yes

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Check all that apply:

Black or African American

White/Non-Hispanic

Asian

Pacific Islander

Native American

Latinx or Hispanic

Prefer not to share

Other

Other (please specify):

*Please Note: Research advocates must be 6 months post treatment.

Have you ever been diagnosed with cancer?

Yes

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*Please choose your diagnosis (check all that apply):

Breast Skin (Melanoma, Basal Cell) Genetics Colon Rectal Liver Pancreatic Stomach/Gastric Bladder Kidney Prostate Testicular Ovarian Uterine/Endometrial Head & Neck (Thyroid, Oral, Throat/Pharynx, Voice Box/Larynx, Nasal, Salivary) Leukemia Lymphoma Myeloma Lung Brain Eye Pediatric (any type of cancer during childhood) Sarcoma Thoracic Other

Other (please specify):

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What year did you receive your diagnosis?

Please describe your relationship to cancer:

Caregiver

Family or friend of loved one with cancer

Healthcare provider

Student

Concerned community member

Have you cared for a loved one with cancer?

Yes

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Please choose the diagnosis (check all that apply):

Other (please specify):

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What year did your loved one receive their diagnosis?

In 2-3 paragraphs, please share what motivates you to become a Research Advocate.

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We recognize the range of ways advocates may prefer to communicate. Please consider recording a short (2-5 minute) video introduction to share with us. This recording can be used to further describe your motivation, experience, or goals for this program.

Upload attachment here.

Upload file

Advocates may have a range of skills and backgrounds. Please tell us about any special skills, training, or experience you have acquired from employment, volunteer work, hobbies or sports, including fundraising or medical writing that will help you to be an effective volunteer. List if you are fluent in any languages other than English including sign language.

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Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

I feel positive regarding my own experience and am emotionally ready to help others.

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I can support the decisions of other people who have made different choices than mine. Being open and unbiased is important to make others feel safe and supported.

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I am comfortable using a computer, the internet, email and MS Word.

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I am familiar with medical terms, scientific methods and/or can grasp them easily.

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I am comfortable communicating verbally and can "hold my own" in a group.

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I consider myself a good listener.

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I am good at written communication.

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List the names of the organizations, volunteer roles and description of responsibilities below

Previous Experience

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Current Involvement

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Training will be provided at no cost to all Research Advocates. This training will be provided by the Research Advocacy Network and Simmons faculty/staff .

A virtual orientation is scheduled for Friday, November 12th 11AM-1PM. The second session is scheduled for November 17th from 3PM-5PM. These sessions will take place over Zoom and require internet connection. Please let us know if you would like resource information on free internet availability in Dallas/Fort Worth.

Follow-up training will take place monthly from December 2021 – September 2022 .

Are you available to participate in these virtual sessions?

Yes No

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How many hours are you able to serve as a Research Advocate per month?

Please provide the name and email addresses of two references. References may be personal or professional.

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Recommend a friend!

If you would like to recommend a friend to serve as a Research Advocate, please include their name and email here:

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