2012 Practice Division Director Application

Thank you for your interest in applying for the ASSH Council's Practice Division Director position. Please complete the following online application and email your electronic CV (your CV may not exceed four (4) pages in length) to Alexzandra Wallace at awallace@assh.org. Send your letters of support via email only to:

Alexzandra Wallace
awallace@assh.org

You are also required to complete the ASSH Conflict to Interest Disclosure. Click here to view the ASSH Conflict of Interest Policy.

To complete your disclosure, please visit the ASSH website in the My Profile section. ou will be asked to login to the ASSH website. Select the "Edit" button in the lower right corner, and then click on “update your disclosures.”


The deadline to apply is March 30, 2012.
Qualifications and Commitments

Please read through the qualifications and commitments expected of all Council members, Council Conflict of Interest Policy, and the specific duties of this position before proceeding.

You are required to complete the ASSH Conflict to Interest Disclosure. To complete your disclosure, please visit the ASSH website in the My Profile section. Click on "Edit" in the lower right corner, and then click on the "Conflict of Interest" tab.
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1. Please enter your name and email address.
2. I have read the description for the position for which I am applying, and I appreciate the responsibilities associated with such position. I hereby represent that, if appointed to such position, I will commit myself to the position and will fulfill such responsibilities to the best of my ability.
3. If elected to the Practice Division Director position, I will serve the complete three year term.
4. Year you joined ASSH:
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5. Primary employer:
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6. Board certification:
In the questions below, please indicate what past volunteer contributions you have made to the ASSH and when they took place in the following categories: Committees, Course chair, and Instructor.
7. Committees
8. Course Chair
9. Instructor
10. Areas of interest/expertise within medicine that would enhance your Council board participation:
11. Interests outside of medicine that could enhance your contributions to the Hand Society in general:
Please use the space provided to note your experiences that are specific to Practice Management
12. Please list any Leadership Positions you have held in the following areas:
13. Experience with Advocacy and/or Government affairs:
14. Any skills that are specific and applicable to the Practice Director position:
15. What experience do you have within this division that is relevant to your application for this director position?
16. What is your vision for the evolution of the Practice Division in the next three years?
17. Names of 2 ASSH members who will be writing letters of support.

Note: It is your responsibility to have these two members email their letters of support to Alexzandra Wallace
awallace@assh.org at the ASSH Central Office by March 30, 2012.

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