MOTION stakeholder form
MOTION stakeholder form
Organisation name
*
What are your organisation's core functions?
*
Multiple Choice
*
Multiple Choice
Rehabilitation
Assistive technology
Robotics
Smart textile
Orthotics and Prosthetics
Health services
Reimbursment
Regulatory services
Research
Other
Other
Who would be the key contact in your organisation for MOTION project?
Name
Who would be the key contact in your organisation for MOTION project?
Name
*
First
Last
Job title
*
Email
*
Phone
What products and/or services does your organisation provide? (select multiple)
What products and/or services does your organisation provide? (select multiple)
Health insurance
Training/education
Product components/End product
Data processing
Funding
Software
Hardware
Support/advice
Commission services
Other
Other
What sector does your organisation belongs to? (select multiple)
What sector does your organisation belongs to? (select multiple)
Public health sector
Private sector
Patient
Academic
Third sector/charity
Area of operation of your organisation? (select multiple)
Area of operation of your organisation? (select multiple)
Belgium
England
France
The Netherlands
Europe
Worldwide
Number of employees
Number of employees
<10
<50
<250
>250
Which products of MOTION project would your organisation be interested in?
Which products of MOTION project would your organisation be interested in?
smart textile
lower body exoskeleton
ankle exoskeleton
What areas would you be interested during the project?
What areas would you be interested during the project?
User design
User acceptance testing
Patient /user input
Heath service design
Training/education
Manufacturing
Provision of products
Awareness/updates
Promotion of members
Building networks
Distribution
Is there anything else you would like to contribute to the MOTION project?
Extremely interested
Very interested
Somewhat interested
Slightly interested
Not interested
Are you interested in engaging in the categories which we have discussed?
Are you interested in engaging in the categories which we have discussed?
Extremely interested
Are you interested in engaging in the categories which we have discussed?
Very interested
Are you interested in engaging in the categories which we have discussed?
Somewhat interested
Are you interested in engaging in the categories which we have discussed?
Slightly interested
Are you interested in engaging in the categories which we have discussed?
Not interested
Extremely relevant
Very relevant
Somewhat relevant
Slightly relevant
Not relevant
Thinking about your knowledge of the MOTION project, how relevant to the project do you perceive your organisation?
Thinking about your knowledge of the MOTION project, how relevant to the project do you perceive your organisation?
Extremely relevant
Thinking about your knowledge of the MOTION project, how relevant to the project do you perceive your organisation?
Very relevant
Thinking about your knowledge of the MOTION project, how relevant to the project do you perceive your organisation?
Somewhat relevant
Thinking about your knowledge of the MOTION project, how relevant to the project do you perceive your organisation?
Slightly relevant
Thinking about your knowledge of the MOTION project, how relevant to the project do you perceive your organisation?
Not relevant
Future elements of the project include workshops and collaborative events. Would you be interested in attending one and engaging with other organisations?
Future elements of the project include workshops and collaborative events. Would you be interested in attending one and engaging with other organisations?
YES
NO
MAYBE
Commercial information
Initially, we are collecting the information contained on this form for use in connection with the MOTION project. If you become a stakeholder, we intend to collect further information for the project including items we ask for and unsolicited details you may supply.
We intend to share this information with the project partners via the MOTION project website, and KSS AHSN website, through a visualisation tool. Our project partners may share this on their websites.
The visualisation tool uses Tableau to display where stakeholder’s expertise and interests fit within the MOTION project. Using information obtained through this form and the stakeholder’s website, the visualisation will include an overview of the stakeholder alongside their stated interests in the project. Information of a sensitive nature, such as number of employees and private contact details, shall not appear on the visualisation tool. However, this information will be available to project partners.
MOTION project partners are:
HEI-YNCREA Hauts-de-France, France
Centexbel, Belgium
Thomas More University of Applied Sciences, Belgium
University of Greenwich, England
University of Kent, England
Kent Surrey Sussex Academic Health Science Network, England
Rehabilitation Center for children and youth Pulderbos, Belgium
Kinetic Analysis, The Netherlands
Canterbury Christ Church University, England
Sussex Community NHS Foundation Trust, England
KU Leuven, Belgium
Commissionership for Atomic Energy and Alternative Energies, France
Sint Maartenskliniek, The Netherlands
My organisation agrees with the stated use of information
*
My organisation agrees with the stated use of information
Individual privacy
Initially, we are collecting only the key contact information contained on this form to communicate with your organisation about MOTION project. With your permission we may collect the details of other contacts in your organisation. Data will be collected on this form and may in future be collected in various ways including email and online forms.
We will:
· only use your personal contact details in connection with the project
· not share that information outside of the project
· only use general company contact details on the visualisation tool unless agreed otherwise
· retain the information for the duration of the project and for a reasonable time afterwards to allow follow up
· update your contact details and remove them upon request at any time
You may be contacted by MOTION project partners as a result of submitting this form, but only about the project. You agree receiving news related to MOTION project. We and our project partners will not send you or your colleagues any marketing information.
I agree with the use of my personal details as described above
*
I agree with the use of my personal details as described above
Spam Protection. Please answer this simple question:
4, 5, 6, 7 : the 1st number is?