Exit Year-round Volunteer Opportunities SHSMD's Year-round Volunteer Opportunities Thank you for your interest in serving as a SHSMD volunteer! Question Title * 1. Member contact information SHSMD ID Number (can be found in recent edition of News Scan) First Name Last Name Title Organization City State E-mail Question Title * 2. Select your choice for SHSMD involvement. Refer to our volunteer opportunities page for details. Micro-Volunteering Member Community Ambassador Question Title * 3. Indicate your years of experience in the following areas: Under 5 years 6-10 years Over 10 years Years in a health care strategy discipline (i.e., planning, marketing, communications, business development, etc). Years in a health care strategy discipline (i.e., planning, marketing, communications, business development, etc). Under 5 years Years in a health care strategy discipline (i.e., planning, marketing, communications, business development, etc). 6-10 years Years in a health care strategy discipline (i.e., planning, marketing, communications, business development, etc). Over 10 years Years in strategy role OUTSIDE of health care Years in strategy role OUTSIDE of health care Under 5 years Years in strategy role OUTSIDE of health care 6-10 years Years in strategy role OUTSIDE of health care Over 10 years Years in leadership role (director or above) Years in leadership role (director or above) Under 5 years Years in leadership role (director or above) 6-10 years Years in leadership role (director or above) Over 10 years Years in SHSMD membership Years in SHSMD membership Under 5 years Years in SHSMD membership 6-10 years Years in SHSMD membership Over 10 years Notes (optional): Question Title * 4. In your current role, what is your level of responsibility? (SELECT THE BEST ANSWER.) CEO/President Vice President or Chief Officer (CMO, CSO, etc) Principal/Partner/Consultant Director or Senior Director Manager Other Professional Other professional (please specify) Question Title * 5. In your current role, what is your primary job function? (SELECT ONE) Business development Communications Customer experience Data analytics Digital engagement Leadership development Marketing Physician relations/strategies Public relations Research methodologies Strategic planning Innovation or Transformation Other (please specify) Question Title * 6. In your current role, what is your secondary job function? (SELECT ONE) Business development Communications Customer experience Data analytics Digital engagement Leadership development Marketing Physician relations/strategies Public relations Research methodologies Strategic planning Innovation or Transformation Other (please specify) Question Title * 7. What are the 3 strengths you could bring as a project volunteer? (SELECT ONLY 3) Creative thinking, innovative ideas Connections to potential collaborators or speakers Facilitating group discussions Thought leadership Developing educational programs Planning skills Scenario planning or other tools for interactive discussions among members Question Title * 8. Provide any additional information about your background that may be useful to your SHSMD volunteer role Question Title * 9. In the PAST 5 YEARS, how many times have you...(SELECT ONE RESPONSE PER ROW) 0 1-5 6 or more Volunteered to serve a SHSMD committee or task force? Volunteered to serve a SHSMD committee or task force? 0 Volunteered to serve a SHSMD committee or task force? 1-5 Volunteered to serve a SHSMD committee or task force? 6 or more Served on a SHSMD committee or task force? Served on a SHSMD committee or task force? 0 Served on a SHSMD committee or task force? 1-5 Served on a SHSMD committee or task force? 6 or more Been nominated to the SHSMD Advisory Board? Been nominated to the SHSMD Advisory Board? 0 Been nominated to the SHSMD Advisory Board? 1-5 Been nominated to the SHSMD Advisory Board? 6 or more Attended the SHSMD Connections annual conference? Attended the SHSMD Connections annual conference? 0 Attended the SHSMD Connections annual conference? 1-5 Attended the SHSMD Connections annual conference? 6 or more Presented at annual conference or SHSMD Education? Presented at annual conference or SHSMD Education? 0 Presented at annual conference or SHSMD Education? 1-5 Presented at annual conference or SHSMD Education? 6 or more Participated in a SHSMD meet up or online discussion (MySHSMD)? Participated in a SHSMD meet up or online discussion (MySHSMD)? 0 Participated in a SHSMD meet up or online discussion (MySHSMD)? 1-5 Participated in a SHSMD meet up or online discussion (MySHSMD)? 6 or more Comment (optional) Question Title * 10. What is your highest degree earned? (SELECT ONE) Bachelor's Master's Doctorate Other (please specify) Question Title * 11. Which of the following recognition's have you received? (SELECT ALL THAT APPLY) SHSMD Rising Star Recognition Other Award in Strategy Professions (describe below) SHSMD Leadership Excellence Award (formerly AIPE) Other Professional Award (describe below) None of the above Year Received / Other Comments Question Title * 12. What is your organization's locale? Rural Suburban Urban Multiple of the above (e.g., system with various locations) Other (please specify) Question Title * 13. What is your organizational affiliation? (SELECT THE BEST ANSWER) Academia/University Association Consulting Firm Health System - multihospital Hospital - standalone Other Health Care Provider Solution provider or vendor Other (please specify) Question Title * 14. Do you plan to attend the SHSMD Connections 2024 Annual Conference in Denver, CO on October 14-16, 2024? Yes No Uncertain Question Title * 15. In a few words, please describe your ideal volunteer experience with SHSMD: Question Title * 16. If asked to serve, I am confident I will meet the time commitments described in the leadership opportunities and will actively contribute to the achievement of committee or project objectives Agree Unsure Disagree Question Title * 17. OPTIONAL: What is your age? 18 - 25 years 26 - 35 years 36 - 45 years 46 - 55 years 56 - 65 years 66 - 70 years 70 + years Question Title * 18. OPTIONAL: What best describes your race? American Indian or Alaska Native Asian or Asian American Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White or Caucasian I do not identify with any of the races listed - and would like to be classified as "Other" I do not feel comfortable disclosing this information Other (please specify) Question Title * 19. OPTIONAL: Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group? Yes No Question Title * 20. OPTIONAL: What is your current gender identity? Male Female Transgender Male/Trans Male/Female-to-Male (FTM) Transgender Female/Trans Woman/Male-to-Female (MTF) Genderqueer, neither exclusively male or female Another gender category, please specify Prefer not to answer Question Title * 21. OPTIONAL: Do you think of yourself as: Straight or heterosexual Lesbian, gay, or homosexual Bisexual Something else Don't know Prefer not to answer Question Title * 22. OPTIONAL: Do you identify as an individual with a disability? (SELECT ALL THAT APPLY) Yes, a physical disability Yes, a learning disability Yes, other type of disability No Prefer not to answer Comment Next >>
