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Community Engagement Request Form

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Project Definition

What is the project trying to achieve and by when?
7.  

What stage are you at in your project?

Stakeholders can include: patients, clients, family members, caregivers, public

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Examples include: written content and graphics, policy, design elements for a development (i.e., colour palette, art, layout of room, outdoor space), how and what services are provided, and more.

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Examples include: creating new programs, design guidelines, whether the project/initiative will happen, and more.
The outcomes you think will be achieved.
Our team will work back from this date to determine when we create an engagement plan and implement the plan.

Stakeholders 

14.  

Please select who will be most impacted by the decision(s) being made:

Examples include: demographic information, barriers to participation, location, and more.

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Examples include: controversial topics, previous negative engagement experiences, disagreement between key participants, and more.
17.  

How many people do you expect we should hear from during this engagement?

Examples include: mailing list, existing committee, previous engagement(s)

Level of engagement

"Level of engagement" refers to how involved stakeholders (patients, clients, consumers, residents, families, organizations, public) will be in this process as well as their level of influence. All the levels create a "spectrum of involvement". 

Visual of the IAP2 spectrum of engagement: left to right there is increasing level of public influence that goes from inform, involve, consult, collaborate, empower.This spectrum is adapted from the International Association for Public Participation (IAP2) and is found in the Ministry of Health's Patient, Family, Caregiver and Public Engagement Framework (2018). 

18.  

Please indicate below which level(s) of engagement you are seeking. You may select different levels depending on those you have in mind to engage.