Complete this form to apply for a position on an AHCC Committee. See this AHCC blog post for links to the Scopes of Work for all AHCC Committees. Note: You must be an AHCC member to serve on an AHCC committee.

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* 1. Please provide your name, credentials, and contact information.

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* 2. Please indicate the type of organization for which you work.

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* 3. How long have you worked in home health or hospice?

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* 4. Are you a BMSC credential holder? (Please note, all certification committee members must hold at least one BMSC credential.)

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* 5. Which BMSC credentials do you hold? (Select all that apply.)

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* 6. Please upload your head shot and professional bio in one file.

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* 7. Which AHCC Committee would you like to serve on? (Select all that apply.)

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* 8. Please describe your level of experience with the subject area covered by the exam the committee you wish to join.  Please include the length of time you have been working in this area and how you achieved your experience.

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* 9. Do you have any previous experience on a certification committee or board? If so, please describe.

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* 10. Why do you want to serve on an AHCC committee?

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* 11. What's one thing you would like to see the AHCC committee you are interested in serving on improve through its work?

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* 12. What's one way AHCC and BMSC can better promote certification among home health and hospice professionals?

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* 13. This position requires volunteer hours during traditional 8 a.m. to 5 p.m. work hours. Have you obtained permission from your direct manager/supervisor to participate in meetings, email correspondence, and other like responsibilities?

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