Expression of Interest in PRIME

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Name and Surname *

Country of Origin: *

Occupation : GP/ Mental health *

How did you find out about PRIME: *

Current Affiliation: *

Which PRIME team are you interested in working with? *

Please summarise briefly your prior discussions or collaboration with any PRIME partners *

Which area(s) of PRIME's work do you see yourself getting involved in? Capacity building, Policy, Research *

Policy

Media

Capacity Building

Select all that apply:

How do you see yourself becoming involved in PRIME? Specifically, how can you contribute to the goals, outputs or impact of PRIME? *

Do you have funding that could cover your collaboration with PRIME? *

If Yes, please specify source of funding under Other

Please indicate what this funding will cover

If you do not have funding, please specify how you will fund the time and costs associated with your work on PRIME?

Submit

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