Applications will close on June 30, 2025. For any questions, please contact cpmembership@facs.org.
General Information

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* 1. Name and credentials

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* 2. ACS member ID number (if applicable/known)

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* 3. Institution/Organization

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* 5. Business phone

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* 6. Specialty

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* 7. What other ACS Committees are you applying to? (You may apply up to 2)

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* 8. Please list other ACS committee(s) you currently serve on.

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* 9. Please attach a copy of your CV or biographical sketch. (PDF file)
*Please note, you are not required to share any sensitive information on your file.

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* 10. Number of years as a practicing cancer professional after completion of training (enter 0 if you are still in training).

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* 11. Cancer discipline

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* 12. Areas of expertise and/or practice. (Check all that apply)

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* 13. Are you a member of any other cancer programs or cancer-related professional organizations? (Check all that apply)

Committee Interest

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* 14. Please select your committee of interest. (Select only one)

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* 15. Please indicate which accreditation program your local institution participates in currently. (Check all that apply)

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* 16. Have you been a site reviewer? (Check all that apply)

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* 17. Have you been a local program leader of your accredited program? (Check all that apply)

Statement of Intent

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* 18. Describe relevant cancer activities that make you eligible and qualified to participate in this committee. (250 words)

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* 19. What contributions would you expect to make towards ensuring that the concerns of all committee members and patients are addressed in the committee's decision-making and activities? (150 words)

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* 20. Describe other relevant activities that make you eligible and qualified to participate in this committee (i.e., work in the field of informatics, analytics, leadership, etc.). (150 words)

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