2020-21 Board of Directors vacancy - Specialist outside HRM

1. Expression of Interest

Question Title

* Full name

Question Title

* Email address

Question Title

* Contact number

Primary

Alternate

Question Title

* Do you have experience serving on any Boards or Committees?

Question Title

* Please indicated if you have one of the following leadership designations:

Doctors Nova Scotia Physician Leadership Development Program certificate

Canadian Medical Association Physician Leadership Institute (PLI) certificate

Canadian Certified Physician Executive Credential

Other (please specify):

Question Title

* Please list any physician leadership courses or programs you have completed within the past 5 years (excluding those identified in previous question).

Question Title

* Please explain why you are interested in serving on the Board of Directors.

Question Title

* Please include any other information you would like to be considered in the selection process.