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Thanks for your interest in joining PPIC! Our network seeks participants interested in driving positive change in the healthcare system as a result of their lived experience as a patient, family member, caregiver, or community member. PPIC is also open to healthcare professionals who are interested and passionate about patient and family engagement, community engagement, and health equity. PPIC members have contributed to many healthcare improvement activities, including Technical Expert Panels (TEPs), focus groups, measure development and evaluation, validation of curriculum and research surveys, and co-development of health education materials and messaging. To sign up for PPIC, please answer these initial demographic questions so we can learn more about you. We will not share or sell any information about you. We will contact you with engagement opportunities that may interest you. Each engagement opportunity is different, and you can decide which ones you want to apply to participate in based on the subject matter, time commitment, and honorarium. Please contact us if you have any questions or want to learn more about us. Contact Desiree Collins Bradley at Desiree.Bradley@ATWHealth.com.

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* 1. First name

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* 2. last name

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* 3. What is your preferred name or nickname?

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* 4. Email

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* 5. Phone number

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* 6. What is your preferred method of contact?

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* 7. What state do you live in?

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* 8. What city do you live in?

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* 9. Languages Spoken (select all that apply)

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* 10. Are you of Hispanic, Latine, or Spanish origin?

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* 11. Race (Select all that apply)

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* 12. What is your age range?

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* 13. Which gender do you currently identify with?

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* 14. What is your sexual orientation?

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* 15. Have you experienced any of the following health conditions or situations?

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* 16. Do you have a healthcare story that you are willing to share with different audiences?

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* 17. How did you hear about PPIC? (select all that apply)

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