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Nomination Form: Expert Faculty Advisory Group

Thank you for your interest in joining RACMA’s inaugural Expert Faculty Advisory Group for the Faculty of Digital Health and AI Leadership project. Please complete all sections and upload your supporting documents. Nominations close at 5pm AEDT, Monday 23 November 2026. If you have any questions, please contact Felicity Gallagher at fgallagher@racma.edu.au.
1.Please provide your full name(Required.)
2.Please provide your RACMA ID(Required.)
3.Please select your membership category(Required.)
4.Please provide your preferred email address(Required.)
5.Please provide your preferred mobile number(Required.)
6.What Jurisdiction do you work in?(Required.)
7.What is your current role and organisation?(Required.)
Evidence against the selection criteria. Please give evidence for each criterion. Selection will emphasise demonstrated impact and evidence of leadership.
8.Digital health/AI leadership impact (40%)
Describe the visible, demonstrated outcomes from digital health or AI initiatives you have led or materially shaped at organisational, jurisdictional or national level (suggested maximum 250 words)(Required.)
9.Leadership role and standing (20%)
Outline the breadth and seniority of roles you have held, including board, advisory and national positions (suggested maximum 250 words)(Required.)
10.Clinical governance credibility (20%)
Describe how you have applied clinical governance, patient safety, data governance or workforce leadership expertise in a digital health or AI context (suggested maximum 250 words).(Required.)
11.Contribution to the College (10%)
Eligible Fellows and Associate Fellows need to be in good standing with RACMA, with demonstrated contribution to the College (committee, SIG/PASC, mentoring, examining or similar). Describe your engagement with, and contribution to, RACMA (suggested maximum 250 words)(Required.)
12.Depth of experience (10%)
Describe the duration and range of your digital health and AI leadership experience (suggested maximum 250 words)(Required.)
13.Relevant qualifications, credentials or outputs (optional)
List any relevant formal qualifications, AIDH credentials, advisory roles, publications or presentations.
14.Please provide your current CV (word or PDF files only).(Required.)
No file chosen
Please provide two referee statements. Referees must not be your current employees.
15.Referee 1: name, position and organisation(Required.)
16.Referee 1: upload statement(Required.)
No file chosen
17.Referee 2: name, position and organisation(Required.)
18.Referee 2: upload statement(Required.)
No file chosen
19.I confirm neither referee is currently employed by me(Required.)
20.Do you have any current commercial, vendor or industry affiliations?(Required.)
21.If yes, please give details
22.Please confirm you can commit to:(Required.)
23.I understand and agree that:(Required.)
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