IHS Committee Volunteer Application

IHS Committee Application

_{Thank you for your interest and applying to volunteer on an IHS committee to help IHS achieve its mission: To protect, represent, and promote the interests of hearing healthcare and hearing aid professionals.}

_{This application is for standing committees. Members are required to re-apply each committee term.}If you are interested in applying for other volunteer opportunities with IHS (outside of committee service), please complete our Volunteer Interest Form.

_{IHS Committees (click to learn more):}
Time Commitment: Time commitments vary depending on committee. Please refer to the Volunteer Handbook for volunteer descriptions, benefits, and time commitment.

Appointments: Committee appointments are made by the IHS President-Elect for a term of two years. The term for which you are applying is January 1, 2025 to December 31, 2026.
Which committee(s) are you applying for? (select all that apply)*

International Institute for Hearing Instrument Studies (IIHIS)Tinnitus Care Provider OversightInternational Licensing Exam (ILE)Federal & State AdvocacyManaged Care & ComplianceEditorial AdvisoryTask Force Support
Name*

First NameLast Name
Member ID
Phone Number*

Area CodePhone Number
E-mail*
State/Province*
Pronouns
Which category below best describes your age?*

18-2526-3031-4041-5051-6061 or olderPrefer not to answer
How would you describe yourself?*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic, Latino, or SpanishMiddle Eastern or North AfricanNative Hawaiian or Pacific IslanderWhitePrefer not to answerOther
Credentials (select all that apply)*

BC-HISACAAuDMDCCC-AOther
How long have you been licensed?*

1-2 years3-4 years5-6 years7-10 years11-15 years16-20 years21-25 years25+ years
Which of the following best describes your role within the Hearing Healthcare profession?*

AudiologistAudiology assistantEducatorENT-OtolaryngologistHearing Aid Specialist/Hearing Instrument PractitionerResearcherTrainerOther
What is the highest level of education you have achieved?*

High school diploma or GEDACA college course workSome college course work (studies not related to ACA)Associate's DegreeBachelor's DegreeMaster's DegreeAuDPhDMD/DOPrefer not to answerOther
Which of the following best describe you? (Select all that apply)*

Business ownerEmployeeEducatorOther
Are you currently dispensing hearing instruments?*

YesNo
Company Name:
Job Title:
Which brand(s) do you offer and/or with whom do you affiliate?*

Amplifon Corporate RetailGN/Beltone/ReSoundCostcoLucid/HLT/Sam's ClubMiracle-EarOticon/HearingLife RetailSonova/Phonak/Unitron/Connect Hearing RetailStarkey/Audibel/American Hearing CentersWSA/Signia/Widex/HearUSAOther
Why do you want to join the selected committee(s)?*
What previous volunteer experience do you have, if any? (Such as volunteering on an IHS committee, with your local chapter, or in outside organizations)*
How will your experience enhance the work of the committee? *
Optional: Upload your resume.

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Acknowledgment:

The information contained in this application is true and correct to the best of my knowledge.

By submitting this application, I understand that completion of this application does not obligate IHS to engage me on a voluntary basis. As a volunteer of IHS, I agree to abide by the organization’s policies and procedures. I understand that I may be required to sign a Confidentiality Agreement before engaging in a volunteer role.

Volunteers are vital to IHS achieveing its purpose and mission. Volunteers are welcomed and treated as valued and integral members of IHS.
By checking this box and submitting this form, I agree to the above.*

I agree
Thank you for your interest in strengthening the hearing healthcare community and serving IHS!
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