Volunteer Application 1 Start 2 Complete Get involved! The Commission is always looking for enthusiastic volunteers who are interested in advancing the profession by contributing to the Commission. Volunteer service can range from participating in an Item Development Workshop, where you help to write questions for the CCM Exam, to serving on a committee. It is a great way to make an impact to our profession in a very tangible way. Name * Mailing Address * Work Phone * Home Phone * Work Email Address * Preferred Method of Contact * Home Work Current Employer * Current Position * Highest Education Degree Attained * Area of Concentration * List all Certifications and/or Licenses Maintained * Please indicate areas of interest (Please choose any areas you have interest in being involved.) * Ethics and Professional Conduct: Issues opinions regarding the interpretation and application of the Code of Professional Conduct for Case Managers, oversees investigations, and rules on cases involving alleged violations, maintaining strict confidentiality. Governance and Nominations: Oversees the governance of the Commission and evaluated policies and procedures as needed, along with managing the Nominations process for new and returning Commissioners Finance: Reviews financial documents and the policy for Commission investments; recruits and hires independent auditor; receives, reviews, and approves the annual audit and any accompanying management letter; and sets policy for Commissioners’ participation in budgetary activities. Programs & Services: Manages CCMC’s services to the Case Management community with established task forces, sub-committees and work groups for each of these services. These include, but are not limited to, exam administration, eligibility, item writing, role and function, organizational approval, and research strategy. Other Other Area of Interest * List current professional responsibilities (Please highlight and specify financial, writing, communication, leadership responsibilities.) * Relevant experience & background (Related to area of interest) * List your memberships in national organizations over the past five (5) years: How did you hear about us? Referred by a Commissioner or other volunteer? * Have you ever held a professional license or certification that was revoked, suspended, voluntarily relinquished, or placed on probation, or otherwise been disciplined by a professional licensure or certification body? * Yes No If yes, please provide an explanation stating the facts in full * I agree to disclose information about my relationship with industry to determine any actual, potential or questionable conflict of interest should that is required for this committee appointment (This is for disclosure purposes only.) * Yes, I can meet the following expectations: Computer access and ability to receive email and download files. Fax accessibility for both sending and receiving. Ability to participate in conference calls with the possibility of limited travel. Committee assignments must be completed in a timely manner prior to conference calls and/or meetings. Most work is conducted via conference call or email. Committee appointment is for a term of one year. Approximately 40-50 hours of voluntary service is required per year. Independent and group skills required. Submit
