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CCI Volunteer Interest Form

1.Upload the most recent copy of your CV (Required)
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2.Please provide your contact information:(Required.)
3.CCI Credentials Held (select all that apply):(Required.)
4.Other Designations Held (select all that apply):(Required.)
5.What year did you earn your first cardiovascular credential?
6.Work Experience Specialty (select all that apply):(Required.)
7.Do you currently participate in presenting or developing resources that's purpose is to prepare individuals to take or pass a CCI examination?(Required.)
8.Select which describes your current work setting:
OPTIONAL-Diversity, Equity, & Inclusion – Supplemental Survey 
At CCI, we strive to be the recognized credentialing organization for Cardiovascular Technology and emerging medical professionals. You are the heart of CCI. We are committed to inclusion across age, race, religion, sexual orientation, gender and gender identity. You are a part of our identity. With you, we are wholehearted, and we invite you to help us better represent all of CCI by providing additional insight into who you are.  
 
Questions related to diversity, equality, and inclusion can be difficult to ask, and difficult to answer. It is our goal to avoid any perception of bias, or micro aggression. Participation in this part of the survey is completely voluntary, you may respond as you like, or not at all.
9.How do you publicly self-identify?
10.Gender identity-How do you publicly identify?
11.Sexual Orientation How do you publicly identify? 
12.What is your age range?
13.Disability: How do you publicly self-identify?
14.What languages do you speak fluently?   Select all that apply.