OHA EMS Program Boards and Committees Application

OHA EMS Program

Boards and Committees Application

The Oregon Health Authority's Emergency Medical Services (EMS) Program is recruiting members for several new boards and committees as described in EMS Modernization (2024). All appointments will be new appointments, including for members of the EMS Program's previous boards and committees.

Please review the Application Guide prior to applying. Form fields marked with a red asterisk (*) are required; all other fields are optional. For questions or technical difficulties, contact the EMS Program at ems.program@odhsoha.oregon.gov.

Demographic and Contact Information

Preferred Name

If you use a name other than your legal name, by what name do you prefer to be called? (e.g., Thomas --> Tom, Cynthia --> Cindy)

Name Pronunciation

If your name is commonly mispronounced, give a short phonetic explanation of how to pronounce it correctly.

Pronouns

Which pronouns do you use?

She/Her

He/Him

They/Them

Not listed

Email Address*

Provide an email address that you check regularly and that can receive secure documents.

Emergency Phone Number

Phone

Home Street Address*

Home Mailing Address

Provide a mailing address if you do not receive mail at your street address.

Region Represented*

ATAB Map

Select

Affiliation*

List the full name (no acronyms) of the agency, hospital, or organization you represent.

Appointment Type*

New Appointment

Boards and Committees of Interest*

Select all that apply. See the EMS Program website for details on each committee.

EMS Advisory Committee

Time-Sensitive Medical Emergencies Advisory Committee

EMS for Children Advisory Committee

EMS Advisory Board

Other Committees*

If you are not chosen for the board or committee(s) you selected above, are you willing to be considered for other committees?

Yes

Supporting Documents

Both [1] a Letter of Interest (LOI) and [2] a current Resume or Curriculum Vitae (CV) are required to be considered for appointment.

For the Resume or CV, note that the professional experience and affiliations listed will be used to determine your eligibility to serve based on the descriptions/requirements for each board and committee seat.

For the LOI, provide an explanation of your interest and relevant experience to support serving for the OHA EMS Program.

Documents Upload*

PDF formatting is preferred.

Drag and drop files here or

Equal Opportunity Questions (Optional)

One key step towards achieving health equity and antiracism is improving representation across OHA's board and committee membership. It is important that these groups reflect the demographic diversity of Oregonians served by OHA programs and impacted by OHA policies.

Please help us ensure equity for applicants now and in the future by responding to the following questions. Your answers are voluntary, optional, and confidential under state law. OHA will not release or disclose any identifiable information.

For additional information, visit the OHA REALD & SOGI webpage.

Bilingualism/Multilingualism

If you regularly communicate using any language(s) other than English in your personal and/or professional life, please identify which language(s).

Sexual Orientation or Sexual Identity

Please describe your sexual orientation or sexual identity in any way you prefer.

Disability

If you identify as someone with a disability, or as having a physical, mental, emotional, cognitive, or intellectual condition, describe your disability or condition in any way you prefer.

Send me a copy of my responses

Demographic and Contact Information

Position Interest

Supporting Documents

Equal Opportunity Questions (Optional)