2019 Application for Senior ASHE

This is the official application for Senior status with ASHE. All candidates must complete this form in its entirety, include a signature and date.

Before beginning this application, make sure you have 30-45 minutes of uninterrupted time to fully complete the application. You will not have the opportunity to save your answers and return later to complete the application.

Please follow the directions as indicated and answer all applicable questions. After you have completed the application, you will be instructed to upload your supporting documentation and professional photo.

You can download a copy of the Criteria for Senior at www.ashe.org

If you have questions contact Charmaine Osborne at cosborne@aha.org.



The application for Senior status is divided into six (6) parts

Part 1 - Contact information
Part 2 - Professional background
Part 3 - Contribution to the Field
Part 4 - Signature & Date
Part 5 - Supporting Documentation
Part 6 - Submitting your application



Complete the information below and be sure to provide a valid e-mail and phone where you can be reached.



















As a candidate for Senior you must submit documentation to demonstrate you meet the requirements in this area.

All supporting documentation must correspond to the answers, statements, and/or examples you provide on this application.



Individuals must obtain an official letter from ASHE to confirm you have five (5) years or more of consecutive membership (with no break in service) at the time of application.

You must have a recorded join date prior to January 1, 2015 to meet the requirement for Senior.

A copy of this letter must be included as part of your supporting documentation.





Individuals must document two (2) examples of academic/professional accomplishments.

Your documentation must support each example indicated on this application.



Use the drop down menu to make your selection


Use the drop down menu to make your selection


Individuals must document a minimum of 37 contact hours of ASHE/AHA approved continuing education credit earned within five (5) years from date of application.

Education must completed between January 1, 2014 - December 31, 2018.



Documentation must support the total number of contact hours and successful completion of continuing education program.

Please indicate the total number of continuing education hours.



Individual must be actively employed at the time of application and have five (5) years of more of work experience in a position with primary responsibility related to the profession of healthcare engineering/facility management, or as a healthcare architect or engineering consultant.


Supporting documentation must include a copy of your resume to demonstrate years of experience.

Please indicate years of industry experience.






Candidates for Senior must demonstration a contribution to the field by providing examples of achievements/experience in two (2) of the following categories:

1) Leadership
2) Lecturing
3) Publishing.

Please select the two (2) categories (Leadership, Lecturing, Publishing)

Individual must submit supporting documentation that demonstrates you successfully meet the requirements in areas you selected in the drop down box listed below



Document two (2) different examples of leadership positions held within seven (7) years from the time of application.

Examples of leadership experience must be completed between January 1, 2012- December 31, 2018.



Indicate position held, organization and year. Documentation must support answer/example given in the space provided below.

EXAMPLE:
Regional Director, ASHE, 2014



Indicate position held, organization, and year. Documentation must support answer/example given in the space provided below.

EXAMPLE:
Chapter President, HESNI, 2013



Document two (2) different examples of lecturing within seven (7) years at the time of application.

Examples of Lecturing experience must be completed between, January 1, 2012 - December 31, 2018.



Indicate the title, date, name of program/event, and your role in the presentation. Documentation must support the answer/example provided in the space below.

EXAMPLE:
Infection Control in the OR, July 2010, ASHE Annual Conference, Speaker



Indicate the title, date, name of program/event, and your role in the presentation. Documentation must support the answer/example provided in the space below.

EXAMPLE
Performance Management Preparing your FM team for Success, February 2012, IFMA Conference, Co-presenter.



Document articles, white papers, or other publishing examples published within seven (7) years from the time of application.

Examples of Publishing must be completed between January 1, 2012 through December 31, 2018.

EXAMPLE:
#1 - Breaking Barriers Claiming Your Seat at the Table, Inside ASHE, July-August 2010
#2 - Documenting the PDC Process, Management Monograph, ASHE, 2011



Individuals who have selected Publishing as an example of Contribution to the Field, must select the appropriate response from the drop down menu.

Documentation must support you meet the requirement in the category of Publishing.



Indicate title, date, and name of publication. Documentation must support answer/example provided in the space below.

EXAMPLE
Documenting the PDC Process, 2011, Management Monograph written for ASHE



Indicate title, date, and name of publication. Your portfolio must include supporting documentation for this example.

EXAMPLE
Health Facility Design Information Checklist, 2016, Management Monograph, written for ASHE




Sign and date your application by indicating a check mark in the Signature box below.



Please enter your full name as you would like it to appear in print.(include prefix, suffix, and designations)




Feel free to include any comments, or other relevant information specific to your application.



Candidates for Senior will be required to provide supporting documentation that will be reviewed by the committee in order to determine your eligibility for the Senior designation. The supporting documentation validates the answers/statements you provide on your application.

To ensure a thorough review of your application, be sure your supporting documentation is compiled and organized for easy reference and verification, as indicated below:

Cover page
- Full Name
- Company
- Phone
- E-mail

Professional Background
- ASHE membership
- Academic/Professional
- Continuing education
- Professional resume

Contribution to the Field (only two categories are required for Senior)
- Leadership
- Lecturing
- Publishing



Carefully read and follow the instructions below.
You will upload two (2) separate files/documents.

File 1 - Supporting documentation
Make sure that you have compiled and scanned all required documentation as one (1) PDF file.

File - 2 Professional photo (headshot)
Your professional photo must be a high-resolution photo in JPEG file format.



To upload your documents hit UPLOAD, search/enter the document name from your computer hard drive or zip file.

Repeat process to upload the second file/document.

Maximum file limit (total of both files) should not exceed 30MB.




You are responsible for the accuracy and completeness of your application. Before you submit your application, go back and review your answers to be sure you have completed the application in its entirety; uploaded the required information, and check that you have signed and dated your application.

To receive a copy of this application via e-mail, simply check the box marked "Send me a copy of my responses" at the bottom of this application form.

Once you hit SUBMIT you will get a Thank You notification of receipt via e-mail.

If you have questions contact Charmaine Osborne at cosborne@aha.org.


Thank you.







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