Position / Qualifications^*

Research Institution / Organisation^*

If Other, please specify (institution)^*

Contact Phone number^*

Link to website / research info (Information will be publicly displayed on website)

Title of project (Information will be publicly displayed on website)^*

If Other, please specify (Type of research)^*

At which stage of your project are you seeking input from Kidney Health Australia? Feedback / input on planning / Study designDemonstrating consumer involvement on grant applicationsImplementation of projectPromotion of research / survey to consumers via our social media & consumer networksOther

If Other, please specify (Project stage)

Please provide a brief description of your research project including criteria for recruiting consumers and what consumers are required to do.^*

Please provide a detailed overview of your research project, including the project background, objectives, consumer recruitment criteria, what consumers will be asked to do, expected time commitment, and any key participation requirements. (Information will be publicly displayed on website)

How does your research relate to people with kidney disease?^*

Does your research project have ethics approval? Please provide details.^* YesPendingNoNot required

Please provide ethics approval details^*

Participation Details

Are you looking for paid or in-kind support from Kidney Health Australia

What is the time commitment and/or frequency required for consumers? E.g. monthly, 1 hour every 3 months etc.^*

Would consumers be reimbursed for their time or are you seeking in kind support?^*

If Other, please specify (reimbursement)^*

How will working with Kidney Health Australia benefit your research?

How will working with you benefit Kidney Health Australia / people with kidney disease?

How do you intend to keep Kidney Health Australia and consumers informed of the outcomes of your research project?

How can interested consumers contact you? Provide contact details below (will be published on the KHA website)^*

How long do you want your listing displayed on our website?^* 90 days unless otherwise notifiedMilestones - start / finish date

Milestones Finish Date^*

This research is appropriate for: Who are you looking for^* Person with early stage kidney diseasePerson on dialysis / transplantFamily / carerHealth professionalOther

If Other, please specify (Who are you looking for)^*

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