The COMPASS Project Team and Global Heart Hub thank you for your interest in this project and for your willingness to contribute your valuable patient perspective. Before completing this application form, please ensure that you have carefully read the Call for Expressions of Interest. We appreciate the time you dedicate to this process and kindly ask that all sections of the form be fully completed with accurate information before submission.

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Privacy Notice about your data: To consider your application as a patient advisor for the COMPASS Project, we have to collect personal data from you to evaluate your application and contact you. Should you be selected, we will store your contact information for the duration of the project (60 months). Should you not be selected, your data will be deleted within a month after the selection process is completed.

The data you provide will be processed by GHH under the General Data Protection Regulation (Regulation (EU) 2016/679). As such, you have the following rights with regards to the data you provide:
- Right of access – You have the right to request a copy of the Personal data that we hold about you.
- Right of correction – You have the right to correct Personal Data that we hold about you that is inaccurate or incomplete.
- Right to erase – You have the right to ask GHH to delete or remove Personal Data from our records
- Right to restrict – You have the right to restrict the processing of your Personal Data.
- Right to transfer – You have the right to have the Personal Data we hold about you transferred to another organisation.
- Right to object – You have the right to object to certain types of processing such as direct marketing, as well as processing we undertake based on our legitimate interests.

For our complete privacy policy, please read more about it here. Should you have any questions, comments or concerns for this survey or regarding your data please contact Global Heart Hub EU Projects Associate at valerie@globalhearthub.org.
Personal Information

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* 1. First Name

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* 2. Last Name

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* 3. Date of Birth

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* 4. Permanent Address

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* 5. Email Address

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* 6. Gender

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* 7. Level of English

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* 8. What other languages do you speak?

Experience with your condition

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* 9. Do you have lived experience of (select all that apply):

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