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AASM-Board-and-Nominating-Committee-Interest-Form-Questionnaire2024-07-31T12:26:04-05:00

2024/2025 Board of Directors and Nominating Committee Interest Form and Questionnaire

Step 1 of 4

25%

Submissions due November 19, 2023 at 11:59 pm

Submit this form and all required attachments by November 19th, 2023. Please review the AASM Conflict of Interest Policy before volunteering. Only voting members may serve on the AASM Board of Directors.

Nominee To-Do List:
  1. Login to your AASM member profile. Make sure your affiliations, contact information and diversity, equity and inclusion data are up to date and complete.
  2. Upload the following documents:
    1. CV, Resume, or Biographical Sketch

Section 1: Background Information

Prefix(Required)
First Name(Required)
Middle Name
Last Name(Required)
Suffix
Primary Specialty(Required)

Practice Type(Required)

Patient Mix: Please note what percentage of your patients are adult vs. pediatric

Please enter a number from 0 to 100.
Please enter a number from 0 to 100.

Sleep Disorders Mix: What estimated percentage of your work involves treatment of the following sleep disorders:

Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.

Payer Mix: Please note your estimated payer mix (if known):

Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.

Are you Board Certified in Sleep Medicine?(Required)

AASM Leadership Experience

Are you an AASM Fellow?(Required)
Have you ever served as Chair of an AASM committee/task force/panel/course?(Required)

State Medical Licensing Board Disclosures

Have any disciplinary actions been threatened, initiated or are any pending against you by a state licensure board?(Required)
Has your license to practice in any state ever been denied, limited, suspended or revoked, diminished, not renewed, relinquished (whether voluntarily or involuntarily) or are any proceedings currently pending which may result in such action?(Required)

Required Attachments

Max. file size: 128 MB.

Section 2: Questions for Prospective Board Members / Nominating Committee Members

To assist the Nominating Committee and Board of Directors in their effort to identify applicants who will provide the best fit for the AASM and the needs of the Board and Nominating Committee in the years to come, please answer each of the following questions. Suggested word length for each question is 100-250 words. We ask that you do not exceed 300 words in any of your responses. Please write one sentence to a few paragraphs in response to each of the following questions, to assist the Nominating Committee and Board of Directors in their effort to identify applicants who will provide the best fit for the AASM and the needs of the Board and Nominating Committee in the years to come.
Which position(s) are you applying for:(Required)

Section 3: Leadership Profile

Please review the nine board leadership competencies (below). Choose three that you feel represent your greatest strengths. Comment on how you feel these qualities would positively impact your ability to fulfill a leadership role on the board. Please limit your responses to 200 words or less for each of the 3 chosen strengths.

1. Knowledge of the Organization

Having and using knowledge of systems, situations, pressures, and culture inside the organization to identify potential organizational problems and opportunities; perceiving the impact of decisions on other components of the organization through

  • understanding and using organizational policies and systems to solve problems
  • anticipating impact of actions on other groups

2. Developing, Communicating, and Sustaining a Vision

Creating and achieving a desired future state (vision) through influence on organizational values, individual and group goals, reinforcements, and systems by

  • defining a desired future state
  • communicating direction with enthusiasm
  • gaining commitment to vision and values

3. Integrity /Responsibility/ Accountability

Maintaining and promoting social, ethical, and organizational norms in conducting internal and external business activities by

  • sharing complete and accurate information
  • maintaining confidentiality
  • adhering to policies and regulations
  • meeting personal commitments and promises
  • setting high performance standards

4. Negotiation

Effectively exploring alternatives and positions to reach outcomes that gain all parties' support and acceptance by

  • exploring others' needs, concerns, and positions
  • keeping discussions issue oriented
  • seeking win-win solutions

5. Communication

Expressing ideas effectively in individual and group situations (including nonverbal communication); adjusting language or terminology to the characteristics and needs of the audience through

  • expressing thoughts clearly
  • soliciting ideas, suggestions and opinions from others
  • listening to all points of view with an open mind

6. Teamwork/Collaboration

Working effectively with team or work groups or those outside formal lines of authority to accomplish organizational goals; taking actions that respect the needs and contributions of others; contributing to and accepting the consensus by

  • exchanging information freely
  • supporting group decisions
  • putting group goals ahead of individual goals

7. Leadership/Motivating Others

Using appropriate interpersonal styles and methods to inspire and guide individuals toward goal achievement; modifying behavior to accommodate tasks, situations, and individuals involved through

  • focusing on the situation, not the person
  • asking for and gaining commitment to action
  • mutually agreeing on accomplishments

8. Innovation

Generating creative solutions to work situations; trying different and novel ways to deal with organizational issues and opportunities by

  • approaching job with imagination and originality
  • generating novel solutions
  • suggesting new ways to apply existing knowledge

9. Judgement/Problem Solving

Committing to an action after developing alternative courses of action that are based on logical assumptions and factual information; taking into consideration resources, constraints, and organizational value in all decisions by

  • considering alternatives
  • considering all pertinent facts
  • weighing pros and cons or impact of alternatives

Section 4: Technical Skills Assessment

For each skill listed below, please select the level you feel most appropriately represents your knowledge, expertise, and experience in the particular skill. If you have no experience or knowledge of a skill, please select “None".

Skills:

Technology Innovation
Technology Innovation(Required)
Social Media
Social Media(Required)
Artificial Intelligence
Artificial Intelligence(Required)
Telemedicine
Telemedicine(Required)
Value-Based Medicine
Value-Based Medicine(Required)
Advocacy / Government Relations
Advocacy / Government Relations(Required)
Coding / Compliance
Coding / Compliance(Required)
Payor and Reimbursement Policies
Payor and Reimbursement Policies(Required)
Graduate Medical Education
Graduate Medical Education(Required)
Clinical Guideline Development
Clinical Guideline Development(Required)
Advanced Practice Provider Training
Advanced Practice Provider Training(Required)
Scientific Research
Scientific Research(Required)
Quality Measures (eg MIPS)
Quality Measures (eg MIPS)(Required)
Business Acumen
Business Acumen(Required)
Accreditation Process and Policies
Accreditation Process and Policies(Required)
Patient Advocacy / Engagement
Patient Advocacy / Engagement(Required)
Financial Management
Financial Management(Required)
Compensation / Succession Planning
Compensation / Succession Planning(Required)
Legal Competency / Analysis
Legal Competency / Risk Analysis(Required)
HR Policies and Benefits
HR Policies and Benefits(Required)
Application of DEI Knowledge
Application of DEI Knowledge(Required)
Fundraising / Development Activities
Fundraising / Development Activities(Required)
Strategic Planning
Strategic Planning(Required)
Certification Exam Development
Certification Exam Development(Required)
Mentoring / Training / Teaching
Mentoring / Training / Teaching(Required)
Quality Improvement
Quality Improvement(Required)
Public Health
Public Health(Required)
Community Outreach
Community Outreach(Required)
.technical-skills .gfield_radio{ display:flex !important; } .technical-skills .gfield_label{ display: none !important; }

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