Opening Doors to Research - Expression of Interest form

(*) required fields

1. Title:*
2. Full name:*
3. Telephone Number or Email Address:*
4. Post Code (e.g. CTX 1AB) (We only ask this to gain an understanding of where our applicants are located):*
5. You are applying to join the Opening Doors to Research Group in the Centre for Health Services Studies (CHSS). Please let us know if you have any experience of the following:
Working in Committees
Voluntary Work
Health Service User Involvement
Research
If applicable, please give us some brief details of your experience:  
6. Please state briefly why you would like to be a member of the Opening Doors to Research Group.*  
7. I declare that to the best of my knowledge and belief, all the information I have given is correct. I understand that my personal details will be kept in a password protected folder and all documents containing my details will also be password protected. I understand that CHSS staff who will have access to my details are Dr. Amanda Bates, Paula Loader and Professor Tricia Wilson.*
I agree that I have read and understood the above declaration.