National Kidney Foundation Advocacy Application
Address Line 1
Address Line 2
District Of Columbia
Northern Mariana Islands
Do Not Wish to Answer
Date of Birth
American Indian or Native Alaskan
Black or African American
Do Not Wish to Answer
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White or Caucasian
What's the highest level of school you have completed, or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g. GED)
Some college but no degree
Connection to Kidney Disease
What is your current connection to kidney disease?
I am a kidney patient
I am a family/friend of a kidney patient
I am a living donor
I am a healthcare professional
Type of Connection
I am at risk for kidney disease
I have CKD Stage 1 or 2
I have CKD Stage 3
I have CKD Stage 4 or 5 and not on dialysis
I am on dialysis
I am a transplant recipient
I have kidney cancer
I have kidney stones
A family member/friend is at risk for kidney disease
A family member/friend has CKD 1 or 2
A family member/friend has CKD 3
A family member/friend has CKD 4 or 5 and is not on dialysis
A family member/friend is on dialysis
A family member/friend is a transplant recipient
A family member/friend is a living donor
A family member/friend is a deceased donor
A family member/friend is a deceased patient
A family member/friend has kidney cancer
A family member/friend has kidney stones
What type of transplant did you receive?
What is the cause of your kidney disease
Acute Kidney Injury
Diabetes Type 1
Diabetes Type 2
High Blood Pressure
Minimal Change Disease
Polycystic Kidney Disease (PKD)
Primary Distal Renal Tubular Acidosis
In the past were you any of the following? (Select all that apply)
Transplant from a living donor
Transplant from a deceased donor
Are you a current or former member of an NKF Board of Directors or Medical Advisory Board?
Are you already involved with the National Kidney Foundation (NKF) in other ways?
If so, how are you involved?
Do you have experience with policy/advocacy activities?
If yes, please explain what you have done in the past:
Do you have existing relationships or have you volunteered with legislators at the state or federal level?
If so, could you please provide their name(s) and title(s):
Are you involved with any community organizations, particularly with policy or political advocacy?
If so, which ones and what have you done in the past?
Would you do any of the following:
Meet with Legislators and/or testify before legislative bodies
Submit Letters to the Editor and/or speak to the media
Attend events (Kidney Patient Summit, local galas, community program events, etc.)
Participate in NKF advocacy productions (ex. articles, videos, etc)
If someone encouraged you to apply for NKF's Kidney Advocacy Committee, please type their name(s) here.
Bio and Photo
Tell us about yourself - submit a bio detailing your journey with kidney disease, living organ donation, transplantation, experience as a caregiver or provider. Please feel free to detail any relevant professional or advocacy experience (1 -2 paragraphs).
Submit a Photo
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