Application Form

We are pleased that you have decided to join INPACT — the INNODIA People Living with Type 1 Diabetes Community — and become an INPACT Associate. Please fill out this form and we will get back to you with more information and the next steps.

Please also send your CV to inpact@innodia.org.

Please note: we are currently in a holiday period, so the email with your credentials may be delayed. We will attend to your request as soon as we are back on 1 September. Thank you for your patience.
Thank you — your application has been received.
The INPACT team will be in touch soon. You will be redirected to innodia.org shortly. Please note that we are in a holiday period, so the email with your credentials may be delayed. We will attend to your request as soon as we are back on 1 September. Thank you for your patience.

Your Details

Pick your country from the flag dropdown — the dial code is added automatically.

About you

If unsure, use day 1 of month 1 of the relevant year.

Your clinical Type 1 Diabetes stage, if you know it:
Stage 1 — 2 or more IAb+, normal glucose levels, asymptomatic, pre-clinical T1D
Stage 2 — 2 or more IAb+, abnormal glucose levels (dysglycemia), asymptomatic, pre-clinical T1D
Stage 3 — Clinical T1D diagnosis per ADA criteria, symptomatic
Stage 4 — Established T1D

Place of residence

Caregiver status

Languages

One language per line, in the format Language : Fluency. Allowed fluency levels: Native, Advanced, Intermediate, Basic.

How you found us

Privacy

The email contacts and personal data provided through this questionnaire will be included in the INNODIA database in accordance with the INNODIA — INPACT Privacy Policy — v2 and the General Data Protection Regulation (EU) 2016/679 (GDPR). By completing this questionnaire, the respondent confirms to have read and understood the INNODIA — INPACT Privacy Policy — v2 and agrees to the use of their personal data as described therein, in compliance with the GDPR.