Committee Experience Program – Expression of Interest

Committee Experience Program – EOI

Please fill out this form to express your interest in joining the committee(s) of your choice.
Name*

TitleFirst NameLast Name
ACEM ID*
Email*
example@example.com
Mobile phone number*
Are you of Aboriginal or Torres Strait Islander origin?*
I am a*

MemberTrainee
Membership category*
Location*
Interested Committees (select up to three)*

Health System Reform CommitteePublic Health and Disaster CommitteeResearch CommitteeStandards and Endorsement CommitteeEvents Advisory CommitteeIndigenous Health CommitteeInclusion CommitteeWorkforce Planning Committee
The ACEM Core Values of respect, integrity, collaboration and equity define the organisation’s guiding principles, and underpin the way ACEM works in order to meet its vision and mission of ensuring the highest standards are maintained in the training of emergency physicians, and in the provision of emergency care to the communities of Australia and Aotearoa New Zealand. From the start of 2022, all future appointees to ACEM roles and entities are required to have completed the ACEM Core Values Module by the close of the applicable Expression of Interest process and to demonstrate their commitment to the ACEM Core Values within their workplace.

If not, please ensure that the Module is completed by the close of expressions of interest in order for your application to be considered.
Have you completed the ACEM Core Values Module?*

YesNo
Please describe how you demonstrate a commitment to all four ACEM Core Values within your workplace (maximum 500 words)*
Have you completed all three ACEM Assessing Cultural Competence Modules. If not, you must be completed by the close of expressions of interest, otherwise your application will not be considered.
Have you completed all three ACEM Assessing Cultural Competence Modules?*

YesNo
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Health System Reform Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Public Health and Disaster Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Quality and Patient Safety Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Regional, Rural and Remote Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Research Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Standards and Endorsement Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Events Advisory Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the ACEM Foundation Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Indigenous Health Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Inclusion Committee. (Max 500 characters)*

0/500
Please include a short statement of suitability/intent, indicating knowledge, interest and relevant skills to the Workforce Planning Committee. (Max 500 characters)*

0/500
Should be Empty:

Committee Experience Program – EOI