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* 1. Contact information

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* 2. How long have you been a member of Digital Health Canada 

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* 3. Why do you want to join the Digital Health Canada Board of Directors at this point in your career?

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* 4. How does your experience align with the Digital Health Canada strategic plan and mandate?

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* 5. What unique skills, perspectives and contributions would you bring to the Digital Health Canada Board?

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* 6. Do you or have or have you ever had any direct patient care experience (clinical)?

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* 7. What segments within the Digital Health Canada community do you feel you will best represent? Select all that apply.

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* 8. With which Digital Health Canada committees, task groups or activities have you volunteered in past five years? Describe your most significant contributions to Digital Health Canada's mission.

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* 9. What other board appointments or relevant leadership experiences have you had in the past five years?

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* 10. Please tell us why you feel Digital Health Canada members should vote for you.

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* 11. Do you currently hold the Certified Professional in Healthcare Information and Management Systems – Canada (CPHIMS-CA) credential?

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* 12. What is your educational background? Please list all degrees and designations.

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* 13. Please include a brief biography including highlights of experience and expertise in health informatics/digital health.

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* 14. Who is nominating you for this position? (Nominator 1 of 3)

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* 15. Nominator 2 of 3

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* 16. Nominator 3 of 3

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* 17. Nomination and Consent Form (DOWNLOAD)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 18. Nomination and Consent Form (copy)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 19. Nomination and Consent Form (copy)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 20. Please use the link below to upload a recent portrait photo (head and shoulders) for posting on the Digital Health Canada website.

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