EpilepsyDisease.com Patient Leader Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Would you like to share your experience with epilepsy and help others who are also living with the condition? Whether you live with epilepsy yourself or are a caregiver to someone who does, we're looking to add new voices to our Patient Leader team and would love to meet you!

Our Patient Leader team consists of our contributors and moderators at EpilepsyDisease.com. Contributors are asked to write 1-3 original articles a month which focus on sharing their personal experiences with epilepsy.

Moderators provide our community members with information and support by responding to questions and comments on our website and Facebook page, while implementing our community rules. Moderators do not provide medical advice, but can share their own experiences. All Patient Leaders are compensated and no prior experience is required. Paid training will be provided.

If you're interested in applying to be an EpilepsyDisease.com Patient Leader, please fill out the form below.

Name *

Age *

E-mail address *

Are you located in the U.S.? *

Yes

What time zone are you located in? *

Which Patient Leader roles are you interested in? *

Contributor – contributors write articles sharing their experiences with epilepsy (1-3 articles per month)

Moderator – moderators respond to community members and provide support (1-2 hours a week)

Both moderator and contributor

I’d like more information about the roles

How are you impacted by epilepsy? *

I’m a person with epilepsy

I’m a caregiver (parent, partner, etc.) of someone with epilepsy

I work with people with epilepsy

How long have you been impacted by epilepsy? *

Less than 6 months

6 months – 1 year

1–3 years

3–5 years

Over 5 years

What type of epilepsy do you have? (Or if you're a caregiver: What type of epilepsy does your loved one have?) *

Articles are typically between 500-800 words. Can you commit to writing 1–3 articles a month? *

Yes

Maybe

I’m only interested in being a moderator

Moderators respond to community members and provide support on Facebook and on our website. Will you be available to moderate at least 1-2 hours per week? (Note: There is no minimum hour requirement in this role.) *

Yes

Maybe

I’m only interested in being a contributor

As a moderator, you will respond to community members on Facebook and on our website. How comfortable are you using Facebook? *

Very comfortable

Somewhat comfortable, but need a little training

I’ve used Facebook in the past but am not comfortable

I don’t use Facebook

I’m only interested in being a contributor

What is your previous writing experience? (check all that apply) *

I enjoy writing/journaling as a hobby

I have my own blog

I have published work (book, article, or other)

I am a writer by trade

No previous experience but am excited to try something new

I’m only interested in being a moderator

Required

We’d love to learn a little bit more about you. In 300-600 words, please tell us why you’d like to join our Patient Leader team. If you have a writing sample, feel free to share that with us as well. You can copy and paste previous work or provide a link to your published work. *

Do you have a website, blog, or social media pages you'd like to share with us? Include links below.

Click the "Submit" button below when your application is complete.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Health Union. Report Abuse

Forms