ASE Volunteer Self Assessment Form Question Title * 1. I am interested in serving on the Council indicated below. Council on Cardiovascular Sonography Council on Pediatric and Congenital Heart Disease Council on Perioperative Echocardiography Council on Vascular Ultrasound Question Title * 2. Have you served as a member of an ASE Committee/Task Force/Council or Board? Yes No If yes, please specify. Question Title * 3. Have you served as Chair of an ASE Committee/Task Force/Council? Yes No If yes, please specify. Question Title * 4. Have you participated in any ASE micro-volunteering opportunities (e.g., Hill Day, case contributions for ASE educational products, grading of abstracts, etc.) Yes No If yes, please specify. Question Title * 5. Have you submitted any articles or cases to JASE or CASE, or any other scientific journal(s)? Yes No If yes to "other" scientific journal(s), please specify the journal(s). Question Title * 6. Have you presented as faculty or poster moderator at ASE's Scientific Sessions? Yes No Question Title * 7. Describe any particular strengths or experience you have as they relate to the CV medical community (e.g., in the areas of corporate relations, philanthropy, media relations). Question Title * 8. Describe any specific leadership experience you have in your own institution. Question Title * 9. Describe any specific leadership experience you have in other non-profit organizations. Question Title * 10. Do you participate in any of the following? Local Cardiovascular Ultrasound Society Ongoing training or education at your place of employment If you are involved in training/education, please specify how. Question Title * 11. Does your employer support time for you to participate in ASE assigned activities? Yes No Question Title * 12. Are your ASE membership dues current (December 2019)? Yes No Question Title * 13. Your Name (serves as electronic signature) Done
