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Knowledge Keeper Expression of Interest Form

Applicants are welcome to submit in the language they are most comfortable with: English, French, or an Indigenous Language (please indicate which Indigenous Language). If you need help to submit, please call 1-833-554-1761 and leave a message with your name and contact information and a Reference Group Helper will follow up to assist you.

Please indicate the following:

I would like to express my interest to join the Reference Group as a Knowledge Keeper

I would like to nominate a Knowledge Keeper

First Name

Last Name

How can we contact you? (multiple can be selected)

Phone

Other (e.g. third party)

Please enter your phone number

Please enter your email address

Please describe how we can contact you

Does the Knowledge Keeper know they are being recommended for the membership in the Reference Group?

Yes

Please speak with the Knowledge Keeper to have their approval before completing the next steps to complete the nomination.

Your First Name

Your Last Name

How can we contact you? (multiple can be selected)

Phone

Other (e.g. third party)

Please enter your phone number

Please enter your email address

Please describe how we can contact you

Please enter nominee information:

Nominee First Name

Nominee Last Name

How can we contact the nominee? (multiple can be selected)

Phone

Other (e.g. third party)

Please enter nominee phone number

Please enter nominee email address

Please describe how we can contact you

Do you have a CIHR PIN

Yes

Please enter your CIHR PIN

To express your interest in joining the Reference Group, please submit the following items (Part A & B). Documents (written documents, audio or video files such as .mp3, .mp4, .mov, .wmv, .pdf, .doc) can be uploaded electronically by selecting “choose file” button below.

Part A: Responses to these four questions:

Tell us about yourself and your work as a knowledge keeper.
Being a knowledge keeper means different things in different places. What does being a knowledge keeper mean in your territory?
How have you supported other groups in the past, and how have you helped them overcome challenges?
Why would it be important for you to be a part of the Reference Group?

Choose FileNo file chosen

Part B: A letter of support from your community or a reference that describes your experience working with groups and/or your and role within the community.

Choose FileNo file chosen

To nominate a Knowledge Keeper to join the Reference Group, the following items are required (Parts A, B & C). Documents (written documents, audio or video files such as .mp3, .mp4, .mov, .wmv, .pdf, .doc) can be uploaded electronically by selecting “choose file” button below.

Part A – Questions to be answered by the Knowledge Keeper (may be submitted by nominator on their behalf)

Tell us about yourself and your work as a knowledge keeper.
Being a knowledge keeper means different things in different places. What does being a knowledge keeper mean in your territory?
How have you supported other groups in the past, and how have you helped them overcome challenges?
Why would it be important for you to be a part of the Reference Group?

Choose FileNo file chosen

Part B – Question to be answered by nominator

Tell us why you are nominating this Knowledge Keeper and how you think they could contribute to the work of the Reference Group

Choose FileNo file chosen

Part C – A letter of support from the community or a reference that describes the Knowledge Keeper’s experience working with groups and/or their role within the community.

Choose FileNo file chosen

I found out about this opportunity through:

Someone that shared it with me

My community (including community newsletters)

Indigenous Friendship Centres

CIHR, SSHRC, NSERC, CRCC announcement

Social media (e.g. Facebook, Twitter)

Radio ad

Other

Please explain