Non-Council Committee Member Application

Complete this form to be considered for appointment to a non-Council Committee by Friday, January 15, 2021 at 12:00pm. Prior to completing this form, please review the Application Guide.

Question Title

* 1. Applicant Information

Name *

Member Number

Email Address *

Phone Number *

Question Title

* 2. Eligibility Declaration

The Member resides in Ontario

The Member is not in default of payment of any fees

The Member is not the subject of any professional misconduct, incompetence or incapacity finding in the preceding three years

The Member’s certificate of registration has not been revoked or suspended in the preceding three years for any reason

The Member’s certificate of registration is not subject to a term, condition, or limitation imposed by the Discipline Committee or the Fitness to Practice Committee;

The Member has agreed to and does resign, before taking office, any position such as director, owner, board member, officer or Employee that the Member holds with a Professional Association

The Member has not been disqualified from Council or a Committee within the preceding three years

The Member is not a member of a council of any other College regulated under the RHPA;

The Member is not currently and has not been for the previous year an employee of the College

The Member is not in any default of returning any required form or information to the College

The Member does not have a conflict of interest to serve as a Committee member or has agreed to remove any such conflict of interest before sitting on the Committee or Panel

Question Title

* 3.
Committee Preference

Please rank the Committees in which you are interested in joining (1 being the most preferred & 4 being the least preferred). Refer to the Application Guide for roles and responsibilities of each Committees.

Examination Committee

Discipline Committee

Inquiries, Complaints and Reports Committee

Quality Assurance Committee

Please provide a summary of any qualifications and/or experience related to the committee(s) you would like to be appointed to.

Non-Council Committee Member Application

Question Title

* 1. Applicant Information

Question Title

* 2. Eligibility Declaration

Question Title

* 3.
Committee Preference

Please rank the Committees in which you are interested in joining (1 being the most preferred & 4 being the least preferred). Refer to the Application Guide for roles and responsibilities of each Committees.

Question Title

* 4. Inquiries, Complaints and Reports Committee

Question Title

* 5. Discipline Committee

Question Title

* 6. Quality Assurance Committee

Question Title

* 7. Examination Committee

Non-Council Committee Member Application

Question Title

* 1. Applicant Information

Question Title

* 2. Eligibility Declaration

Question Title

* 3. Committee Preference Please rank the Committees in which you are interested in joining (1 being the most preferred & 4 being the least preferred). Refer to the Application Guide for roles and responsibilities of each Committees.

Question Title

* 4. Inquiries, Complaints and Reports Committee

Question Title

* 5. Discipline Committee

Question Title

* 6. Quality Assurance Committee

Question Title

* 7. Examination Committee

* 3.
Committee Preference

Please rank the Committees in which you are interested in joining (1 being the most preferred & 4 being the least preferred). Refer to the Application Guide for roles and responsibilities of each Committees.