OHA EMS & Trauma Systems EMS Committee Application
By what name do you prefer to be called? (e.g. Thomas --> Tom, Cynthia --> Cindy)
P.O. Box, if appropriate
List the agency you represent.
Will you be uploading a Letter of Interest (LOI)?
Please provide an explanation of your interest and relevant experience to support serving on this committee for the OHA EMS & Trauma Systems program. Put N/A if you choose to submit a document instead of writing a response here. *A LOI IS REQUIRED TO BE CONSIDERED FOR APPOINTMENT TO THE COMMITTEE.*
Will you be uploading a Resume/CV?
* To better assist us in meeting our affirmative action objectives, we would appreciate information about your background and gender identity. This information is optional and is used for data collection only. Under state and federal law, this information may not be used to discriminate against anyone.