2024 Committee Volunteer Form

Volunteer applications are now being accepted for 2025. Committee members will be appointed at the December Council meeting and will begin their one-year term on January 1, 2025.

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* 1. Please provide your full name.

Name

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* 2. I am interested in serving on the following committee(s): (If selecting more than one committee, please rank your selections in order of priority.)

Please note that only members of Council can serve on the Audit/Finance/Risk and Gov-HR Committees.

	First	Second	Third	Fourth	Fifth	Sixth	Seventh	Eighth	Ninth
Discipline	Discipline First	Discipline Second	Discipline Third	Discipline Fourth	Discipline Fifth	Discipline Sixth	Discipline Seventh	Discipline Eighth	Discipline Ninth
Inquiries, Complaints and Reports	Inquiries, Complaints and Reports First	Inquiries, Complaints and Reports Second	Inquiries, Complaints and Reports Third	Inquiries, Complaints and Reports Fourth	Inquiries, Complaints and Reports Fifth	Inquiries, Complaints and Reports Sixth	Inquiries, Complaints and Reports Seventh	Inquiries, Complaints and Reports Eighth	Inquiries, Complaints and Reports Ninth
Fitness to Practise	Fitness to Practise First	Fitness to Practise Second	Fitness to Practise Third	Fitness to Practise Fourth	Fitness to Practise Fifth	Fitness to Practise Sixth	Fitness to Practise Seventh	Fitness to Practise Eighth	Fitness to Practise Ninth
Patient Relations	Patient Relations First	Patient Relations Second	Patient Relations Third	Patient Relations Fourth	Patient Relations Fifth	Patient Relations Sixth	Patient Relations Seventh	Patient Relations Eighth	Patient Relations Ninth
Quality Assurance Committee - QA Panel	Quality Assurance Committee - QA Panel First	Quality Assurance Committee - QA Panel Second	Quality Assurance Committee - QA Panel Third	Quality Assurance Committee - QA Panel Fourth	Quality Assurance Committee - QA Panel Fifth	Quality Assurance Committee - QA Panel Sixth	Quality Assurance Committee - QA Panel Seventh	Quality Assurance Committee - QA Panel Eighth	Quality Assurance Committee - QA Panel Ninth
Quality Assurance Committee - Clinical Practice Panel	Quality Assurance Committee - Clinical Practice Panel First	Quality Assurance Committee - Clinical Practice Panel Second	Quality Assurance Committee - Clinical Practice Panel Third	Quality Assurance Committee - Clinical Practice Panel Fourth	Quality Assurance Committee - Clinical Practice Panel Fifth	Quality Assurance Committee - Clinical Practice Panel Sixth	Quality Assurance Committee - Clinical Practice Panel Seventh	Quality Assurance Committee - Clinical Practice Panel Eighth	Quality Assurance Committee - Clinical Practice Panel Ninth
Registration	Registration First	Registration Second	Registration Third	Registration Fourth	Registration Fifth	Registration Sixth	Registration Seventh	Registration Eighth	Registration Ninth
Audit/Finance/Risk	Audit/Finance/Risk First	Audit/Finance/Risk Second	Audit/Finance/Risk Third	Audit/Finance/Risk Fourth	Audit/Finance/Risk Fifth	Audit/Finance/Risk Sixth	Audit/Finance/Risk Seventh	Audit/Finance/Risk Eighth	Audit/Finance/Risk Ninth
Governance/HR	Governance/HR First	Governance/HR Second	Governance/HR Third	Governance/HR Fourth	Governance/HR Fifth	Governance/HR Sixth	Governance/HR Seventh	Governance/HR Eighth	Governance/HR Ninth

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* 3. Please copy and paste your CV below and/or provide the URL to your LinkedIn profile. If you have difficulty uploading your CV, please email it to Chad Andrews at candrews@collegeoptom.on.ca.

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* 4. Please provide a short summary explaining why you are interested in the Committees you selected above (250-word limit).