CCI Volunteer Interest Form

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* 1. Upload the most recent copy of your CV (Required)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 2. Please provide your contact information:

First Name *

Last Name *

City/Town *

State/Province

Country

Email Address *

Phone Number *

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* 3. CCI Credentials Held (select all that apply):

Advanced Cardiac Sonographer (ACS)

Certified Cardiographic Technician (CCT)

Certified Rhythm Analysis Technician (CRAT)

Registered Cardiac Electrophysiology Specialist (RCES)

Registered Cardiovascular Invasive Specialist (RCIS)

Registered Congenital Cardiac Sonographer (RCCS)

Registered Cardiac Sonographer (RCS)

Registered Phlebology Sonographer (RPhS)

Registered Vascular Specialist (RVS)

None

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* 4. Other Designations Held (select all that apply):

None

CCDS

CEPS

LPN/LVN

RDCS

RDMS

RVT

Other (please specify)

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* 5. What year did you earn your first cardiovascular credential?

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* 6. Work Experience Specialty (select all that apply):

Cardiac Catheterization

Cardiac Electrophysiology

Cardiac Rhythm Monitoring

Echocardiography

EKG Stress Testing and Holter Monitors

Pediatric/Congenital Cardiac Ultrasound

Phlebology/Venous Ultrasound

Vascular Ultrasound

Other (please specify)

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* 7. Do you currently participate in presenting or developing resources that's purpose is to prepare individuals to take or pass a CCI examination?

Yes

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* 8. Select which describes your current work setting:

Hospital

Academic Medical Center

Clinic

Hospital Outpatient

Doctor’s Office

Not employed or Retired

Other (please specify)

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.

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* 9. How do you publicly self-identify?

Asian American/Pacific Islander/Asian

Black/African American/African

Hispanic/Latino/Latina/Latinx

Native American/American Indian/Indigenous

White/Caucasian/European

Multi-racial/Multi-ethnic (two or more races or ethnicities)

Decline to state

Not listed (please specify)

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* 10. Gender identity-How do you publicly identify?

Female

Male

Trans-gender

Non-binary

Decline to state

Other (please specify)

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* 11. Sexual Orientation How do you publicly identify?

Heterosexual or straight

Gay, lesbian, bisexual (or other sexual orientations with the LGBTQIA+ community)

Different identity

Decline to state

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* 12. What is your age range?

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65+ years

Decline to state

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* 13. Disability: How do you publicly self-identify?

I identify as a person with a disability

I do not identify as a person with a disability

Decline to state

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* 14. What languages do you speak fluently? Select all that apply.

English

Spanish

Italian

German

French

Russian

Mandarin

Arabic

Decline to state

Other (please specify)