CF Community Blog Contributor Questionnaire

Thank you for your interest in contributing to the CF Community Blog. Please take a few minutes to complete the form below with information about yourself and what topics you are interested in writing about. We look forward to hearing from you!

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Phone Number

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* 5. City

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* 6. State

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* 7. Age

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* 8. What is your racial or ethnic identity?

African-American or Black

African or Afro Caribbean

Alaska Native

East Asian

Hispanic or Latinx

Middle Eastern or North African

Native American

Native Hawaiian or other Pacific Islander

South Asian

Southeast Asian

White or Caucasian

Not listed above (please specify)

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* 9. Do you consider yourself a member of the Lesbian, Gay, Bisexual and/or Transgender (LGBTQ+) community?

The Foundation does not discriminate on the basis of sexual orientation, gender identity, or expression. In order to track and ensure the blog represents all perspectives of the CF community, please consider the following optional question.

Yes

Prefer not to say

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* 10. What is your connection to CF?

I am personally living with CF

I am a parent of someone living with CF

I am a spouse/partner of someone living with CF

I am a caregiver of someone living with CF

I have a family member living with CF

I am a friend of someone living with CF

I work at a CF care center

I am a researcher studying CF

I have no personal connection to CF

Other

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* 11. Are you eligible for a CFTR modulator? CFTR modulators include Kalydeco®, Orkambi®, Symdeko®, or Trikafta®.

Yes, I am/my child is eligible and currently taking a CFTR modulator

Yes, I am/my child is eligible but not currently taking a CFTR modulator

No, I am not/my child is not eligible for a CFTR modulator due to my/their CFTR mutation

My child is eligible for Trikafta but is too young at the moment (under 6 years old)

Don't know/Not sure

Prefer not to answer

If these options do not apply to you or you would like to expand, please use the text box below

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* 12. What is the name of your CF care center?

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* 13. Are you involved with your local Foundation chapter?

Yes

If yes, which chapter?

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* 14. What are you most interested in writing about for the CF Community Blog?

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* 15. What other CF-related topics are you interested in writing about?

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* 16. Do you have your own blog?

Yes

If yes, please provide your blog's URL

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* 17. Please provide links to your Facebook, Twitter, Instagram profiles. If you become a contributor, we will tag you in promotions of your blog post.

Facebook

Instagram

Twitter

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* 18. I would like to be considered for additional story sharing opportunities (e.g., speaking engagements, additional blog posts).

Yes

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* 19. I am interested in being connected to other CF Foundation programs based on my background and interests.

Yes