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Person affected by diabetes intake form

Thank you for your interest in getting involved in diabetes research. For all Diabetes Canada-led volunteer opportunities, volunteers will be provided with an orientation and training, or staff support related to their duties. Any costs associated with participation in volunteer opportunities as outlined in your volunteer agreement will be managed by Diabetes Canada.

This form will allow Diabetes Canada to understand your interest and goals in participating in research. Your information will be kept confidential and only shared with Research staff directly involved in managing relationships with people affected by diabetes.

Your participation in this survey is completely voluntary. If you decide to participate, you consent to Diabetes Canada collecting and using the information you provide to us for the purposes of developing and improving our programs, services, and initiatives.  We will not share your personal information with third parties, other than with our affiliates who perform services on Diabetes Canada’s behalf. You can learn more about how we handle your personal information by reading our Privacy Policy.

By providing your contact information, you consent to Diabetes Canada contacting you for participation in diabetes research.

First, please answer some questions related to the volunteer opportunities specifically.
5. By what medium are you able to volunteer? (check all that apply)
6. What Research PAD Partner opportunity are you interested in applying for? (check all that apply)
7. Desired frequency of involvement:
8. Typical availability to participate in research activities:
9. Why are you interested in participating in diabetes research? (check all that apply)
We have a few more detailed demographic questions to better understand the diversity of our community.
1. Diabetes affiliation (select all that apply)
2. In which jurisdiction do you primarily live?
3. Which of the following best describes your racial or ethnic group? Select all that apply.
4. What is your age?
5. What is your gender?
6. Do you identify as a person with a disability? For the purposes of this survey, disability is defined as: any impairment (physical, intellectual, cognitive, learning, communication or sensory) or functional limitation that hinders full and equal participation in society.