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ISQua Board Appointments
Your Details
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1.
Your full name
(Required.)
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2.
Your email address
(Required.)
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3.
Gender
(Required.)
Female
Male
Other/Prefer not to say
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4.
What is your nationality ?
(Required.)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong SAR, China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea, Dem. People's Rep
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR, China
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Lucia
Samoa
San Marino
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
West Bank and Gaza
Yemen
Zambia
Zimbabwe
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5.
Where are you currently employed ?
(Required.)
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6.
What Country/Region are you employed in ?
(Required.)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong SAR, China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea, Dem. People's Rep
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR, China
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palestine
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Lucia
Samoa
San Marino
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
West Bank and Gaza
Yemen
Zambia
Zimbabwe
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7.
What is your professional background?
(Required.)
8.
Please list your current or previous experience on a Board(s), including your position on each Board.
Organisation name, lenght of time, and position on the Board
Organisation name, lenght of time, and position on the Board
Organisation name, lenght of time, and position on the Board
Organisation name, lenght of time, and position on the Board
Organisation name, lenght of time, and position on the Board
Organisation name, lenght of time, and position on the Board
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9.
Please indicate two ISQua members (Individual or Institutional members [official representative of Institution only]) who are willing to support your nomination. Also please include their email addresss .
Please note that we will be contacting your nominees to confirm their support. (Please ask them to reply asap to elections@isqua.org )
(Required.)
Supporter 1: full name and organisation (if Institutional Member) and email address
Supporter 2: full name and organisation (if Institutional Member) and email address
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10.
Rate yourself on a scale from 4 to 1 on the skills listed below:
4 = expert skills
3 = good skills
2 = some skills
1 = minimal or no skills
If you rate yourself 3 or 4, describe briefly the reason for this rating.
(Required.)
Expert Skills
Good Skills
Some Skills
Minimal or no Skills
Inspiring Change: ISQua operates under the tagline Network – Knowledge – Voice – Action. We must be able to inspire and engage members, stakeholders, and other participants in our present activities to take action independently.
Expert Skills
Good Skills
Some Skills
Minimal or no Skills
Strengthening Education: Collaborate with fellow Board Members to enhance our educational initiatives.
Expert Skills
Good Skills
Some Skills
Minimal or no Skills
Global Perspective: Offer strategic advice to meet the unique needs of healthcare systems in Low- and Middle-Income Countries, promoting inclusivity and accessibility in quality and patient safety initiatives.
Expert Skills
Good Skills
Some Skills
Minimal or no Skills
Advisory Services: To support ISQua's consultancy and advisory services, ensuring they remain effective and impactful.
Expert Skills
Good Skills
Some Skills
Minimal or no Skills
Business Development: To support ISQua’s strategic planning and market expansion, identifying new partnerships and opportunities
Expert Skills
Good Skills
Some Skills
Minimal or no Skills
11.
If you rated yourself 'Expert' or 'Good' for 'Inspiring Change', please briefly describe the reason for this rating
12.
If you rated yourself 'Expert' or 'Good' for 'Strengthening Education', please briefly describe the reason for this rating
13.
If you rated yourself 'Expert' or 'Good' for 'Global Perspective', please briefly describe the reason for this rating
14.
If you rated yourself 'Expert' or 'Good' for 'Advisory Services', please briefly describe the reason for this rating
15.
If you rated yourself 'Expert' or 'Good' for 'Business Development', please briefly describe the reason for this rating
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16.
Please Include a statement detailing your motivation to join the ISQua Board and how you envision contributing to our mission.
(Required.)
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17.
Please attach a brief CV (two-page narrative)
(Required.)
Please note that if more than two pages are upload, the information will be ignored and will not be included in the final shortlisting
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18.
Please upload a recent photo (headshot)
(Required.)
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