Providence/Boston CFAR Community Engaged Research Council (C-CERC) Application

The mission of the Providence/Boston CFAR Community Engaged Research Council (C-CERC) is to foster and maintain partnerships and open communication between the populations we serve, community-based organizations, and the Rhode Island and Massachusetts Departments of Health. The goal of the C-CERC is to enhance HIV education, prevention, treatment, and research activities that adequately respond to the interests and needs of our community members, particularly women, individuals struggling with substance addiction, individuals with histories of incarceration, people living with HIV with comorbid conditions, and men who have sex with men. In order to address the concerns of the community, we have established a CFAR specific Community Engaged Research Council. We are looking for volunteers to represent the communities we service. Please complete the following application if you are interested in serving in this capacity.

First Name *

Last Name *

Organization: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Please describe in a short essay, why you would like to become a member of the Providence/Boston CFAR Community Engaged Research Council (C-CERC). *

What relevant experiences in HIV research, prevention, or care/treatment do you bring? *

Please discuss the relevant communities and networks to which you have access (i.e., Corrections, Women, substance users, foreign-born, faith-based, MSM, etc.). *

C-CERC members contribute to research feedback regarding research protocols. Applicants need not have research backgrounds, but should feel comfortable discussing research. Please briefly describe your comfort discussing research. *

Are you currently a Community Advisory Board (CAB) member for another organization/institution? *

Yes

No

If yes, which CABs have you served on? How long? What specific contributions have you made to the CAB?

Type of C-CERC membership (please select one) * 🛈

Are you able to fulfill the following commitments? *

Attendance: Full members must agree to attend bi-monthly meetings. Ad hoc members will attend meetings on an as needed basis.
Orientation: Every new member must agree to participate in all orientation training sessions to be led by the Chair (and/or Co-Chari) and CFAR staff. Training sessions are conducted in-person and online.
Participation: Members should actively participate at C-CERC meetings in a thoughtful & respectful manner. Members are expected to utilize their expertise, initiative, and community networks to further the C-CERC's mission..
Preparation: Members are expected to read all relevant materials prior to the meetings.

Demographics

All information entered is private. Your information will be kept strictly CONFIDENTIAL at all times.

Age (range) *

Gender: *

Male

Female

Transgender

Other

Would you describe yourself as: *

HIV Status (Optional)