CDOC Stakeholder Recruitment

Welcome to the CDOC stakeholder recruitment site. Please complete the following recruitment questionnaire if you would like to join our ever-expanding collaborative coalition of Californians volunteering to work together to reduce the cancer burden in the state.

Recruitment Form

First Name Middle Initial Last Name Degree(s) Title Organization Address 1 Address 2 Address 3 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Phone Number Fax E-mail Address

Add me to the CDOC listserv to receive updates on cancer related issues in California.

Which area(s) of cancer control are you specifically interested in? Rank 1 Please Select..... Access to Care Cancer Type, please specify --> Data and Surveillance Disparities Early Detection Nutrition/Physical Activity Other, please specify --> Palliative Care Research Sun Safety Survivorship Tobacco Control Treatment Rank 2 Please Select..... Access to Care Cancer Type, please specify --> Data and Surveillance Disparities Early Detection Nutrition/Physical Activity Other, please specify --> Palliative Care Research Sun Safety Survivorship Tobacco Control Treatment Rank 3 Please Select..... Access to Care Cancer Type, please specify --> Data and Surveillance Disparities Early Detection Nutrition/Physical Activity Other, please specify --> Palliative Care Research Sun Safety Survivorship Tobacco Control Treatment

Please indicate the type(s) of communications you would like from CDOC.   E-mail   Listserv Daily Digest   Regular Mail   Web Updates

Periodically we have telephone conference calls and/or face-to-face conferences. Would you like to be considered for participation in either of these activities?   Teleconference   In person conference

In general, what level of participation are you willing to engage as a CDOC Stakeholder? Please select..... Information only (e-mail or regular mail) Some active participation (such as planning or teleconference) Active (will consider helping where ever is needed) Very active (will be able to provide additional resources to CDOC)

Please describe any resources you or your organization may be able to provide to help the CDOC mission (e.g. staff time, funding, educational materials, specific training or expertise, etc.).

Does the cancer-related work you/your organization do focus on a particular sub-population of California? If so, please specify (e.g. Korean-Americans, Latinos, under or uninsured populations, etc.)

What are you hoping to gain from your participation in CDOC?

Additional Comments