ICES | Our Organization | 2025 Public Engagement Application Form

Section 1

This information helps us to make sure you are eligible to join the Public Advisory Council and to contact you if needed.

Your Name*

First Name Last Name

Email Address*

City, town, or community in Ontario where you currently live*

How old are you?*

If you are chosen for an interview for the ICES Public Advisory Council, what is generally the best time to have a 30-minute call with you?*

Select all that apply.

Morning (between 9am and 12pm)

Lunch time (between 12pm-1pm)

Afternoon (between 1pm and 4pm)

Early evening (between 4pm and 6pm)

Late evening (between 6pm and 8pm)

Other (please describe):

Where did you hear about the ICES Public Advisory Council recruitment?*

Select all that apply.

Other social media (Instagram, Facebook, Bluesky)

Word of mouth

Other (please describe):

Section 2

The following questions ask you about parts of your identity. We value inclusion, diversity, equity, and accessibility, so we use this information to help us ensure the Public Advisory Council reflects a range of experiences, backgrounds, and perspectives. Feel free to indicate if you prefer not to answer any of the questions below.

What is your current gender identity?

If prefer to self-describe was selected, please describe:

Do you identify as First Nations, Inuk/Inuit or Métis?

Select all that apply.

Please use this space to indicate however you prefer to describe your identity. This may include any racial, ethnic, ancestral, cultural and/or religious factors. You may also choose to skip this question.

For example, racial identities might include Black, East Asian, Latin American and many others and/or combinations of many others. For examples of ethnic or cultural origins, visit: https://www12.statcan.gc.ca/ancestry
For examples of religious identities, visit: https://www12.statcan.gc.ca/census-recensement/2021/ref/questionnaire/religion-eng.cfm

Do you identify as a newcomer to Canada?

Yes

Prefer not to answer

If yes, feel free to briefly describe (e.g., years in Canada, etc.).

What is/are your first language(s) or language(s) spoken in your household(s)?

Please enter N/A if you prefer not to answer.

What is your occupation (including if you are a student, unemployed, full-time caregiver, or on parental leave)?

Please enter N/A if you prefer not to answer.

What education have you completed?

Other (please specify):

Do you identify as a member of the 2SLGBTQI+ community?

The 2SLGBTQI acronym stands for Two-Spirit, lesbian, gay, bisexual, trans, queer and intersex people. The “+” includes other folks who may identify as (but not limited to): asexual, non-binary, pansexual, and those questioning their sexual orientation, gender identity or gender expression.

Yes

Prefer not to answer

Do you live with a disability?

Yes

Prefer not to answer

Tell us a little about yourself in your own words. What else would you like us to know about your identity and the perspectives you would bring to the Public Advisory Council? Feel free, if you are comfortable, to share any key lived experiences that have shaped your outlook on life.

Section 3

The following questions ask you to tell us a bit about your interests. We use this information to help us get to know the applicants better and understand their experience. These questions are mandatory to help us screen all applicants.

What interests you about ICES or research using health data, and why you are interested in being part of the Public Advisory Council?*

Do you have any experience as a public/patient advisor, or have you sat on a volunteer council or public/patient advisory council in the past? Please explain.*

Do you currently work in the healthcare system or health research?*

(E.g., at a hospital, healthcare provider, research institution, Ministry of Health and Long-Term Care, etc.)

Yes

Your Privacy

Your privacy is important to us. ICES will collect and use your personal information solely for public engagement recruitment. Your personal information will not be used or disclosed to others for any other purpose. Only individuals involved in public engagement recruitment at ICES will be permitted to access your personal information. Your personal information will always be retained securely to protect your privacy.

Questions? Email us at [email protected]

Comments

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2025 Public Advisory Council Application Form

Section 1

Section 2

Section 3

Your Privacy

2025 Public Advisory Council
Application Form