Patient Champion Application
Global Health Council (GHC), in partnership with The Medtronic Foundation, will provide support for up to six Patient Champions interested in speaking on behalf of themselves or their communities at key global health meetings (e.g. World Health Assembly). GHC strongly believes in the meaningful inclusion of underserved patients in global health policy discussions, recognizing that health for all will not be achieved without true participation. Priority will be given to those with direct, personal experiences with chronic diseases or other health conditions and interest in continuing their advocacy and amplifying their voice beyond this experience.

If you are interested in participating, please fill out the application form below by Monday, April 1, 2019. Please not that meetings are primarily conducted in English, so a conversational level of English is necessary. If you have any questions, please email advocacy@globalhealth.org.

First Name *
Your answer
Last Name/Surname *
Your answer
Email *
Your answer
Phone Number *
Your answer
Organization (if applicable)
Your answer
Title/Role (patient advocate, caregiver, health worker) *
Your answer
Country *
Your answer
City *
Your answer
Do you have a visa to travel to the US, Canada, and/or Switzerland? (If yes, please indicate visa status below. Please note that your answer will not impact your application) *
Do you hold any other visas? If yes, please indicate the specific country or countries.
Your answer
Please select which months you are available to participate in global health meetings. *
Required
Briefly tell us about you and your global health advocacy efforts (5-10 sentences). *
Your answer
Why do you want to participate in global health advocacy? *
Your answer
How would you include other perspectives, especially those who are underserved, in participating in these discussions? *
Your answer
Where would you like to see health care in five years and how will your participation in this event help us achieve this? *
Your answer
How did you hear about this call for applications? *
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