Exchange Programme Committee Chair

1. APPLICANT PROFILE
1.1 Describe your experience of anaesthetic and intensive care teaching and training nationally.
1.2 Describe your experience of doctors' exchange programmes nationally and internationally.
1.3 Describe your personal experience (if any) as a fellow or trainee abroad
1.4 Describe your experience (if any) in organising/overseeing exams nationally and internationally.
1.5 Upload your Curriculum Vitae (max. 2 A4 pages)

Cancelof

2. ADDED-VALUE & VISION
What are your motivations for applying for this position?
What specific new perspectives, skills or approaches would you bring to this Committee?
(max. 2 A4 pages)

word count:0/1000

3. CONTRIBUTION TO ESAIC & ENGAGEMENT
3.1 Current and Past contributions to ESAIC:
If you have not previously held a formal ESAIC role, please describe other contributions that demonstrate your engagement with another society and its mission.
List the roles you have or had in the Society
3.2 Availability and engagement:
Please confirm and briefly explain:
• Your ability to commit sufficient time and responsiveness to this role? 
• How you ensure continuity and follow-through alongside clinical duties?
• If you have parallel commitments in other ESAIC Committees and/or scientific societies

4. COLLABORATION & VALUES
4.1 Working within ESAIC values:
- ESAIC Code of Conduct
Describe how you ensure that your contributions align with the ESAIC Code of Conduct, particularly with regard to collaboration, managing conflicts of interest and inclusiveness
PLEASE DECLARE ANY CONFLICT OF INTEREST, i.e. relationship or arrangement with a commercial company, direct or indirect, that could be reasonably considered to affect the work in the committee.

This includes, but is not limited to, financial relationships, advisory positions, receipt of grants/research supports, receipt of honoraria or consultation fees, participation in a company sponsored speaker's bureau, stock shareholder, and spouse/partner financial relationships with a commercial company.
Please tick accordingly:
Receipt of grant/research support
Receipt of honoraria or consultation fee
Participation in a company sponsored speaker’s bureau
Stock shareholder
Other support (please specify)
Declaration
Date

MonthDayYear
Signature
Should be Empty:

Exchange Programme Committee