CHSCPR Application Form: At Large Member – Executive Committee


The Chicago Healthcare System Coalition for Preparedness and Response (Coalition) is a collaboration of healthcare organizations and providers, public health departments, and community partners working together to care for our community before, during and after an emergency. The Chicago Healthcare Coalition is an inclusive body open to all organizations/entities that provide or support healthcare services within the City of Chicago that wish to work collaboratively on emergency preparedness, mitigation, response and recovery activities.

Application for:
     o At Large Member (1 open position)
     o Will be a representative of a non-hospital healthcare partner.

A nominee is eligible for an elected position if he/she meets the eligibility requirements:
     1. Active Coalition member;
     2. Attendance at 75% of the prior year’s All Partners Coalition meetings;
     3. Expressed a willingness to serve in the elected position until June 30, 2024; and
     4. Provides a resume/CV/bio for distribution to the membership.

A list of duties associated with each position can be found in the approved governance document.

Please complete the information below which will be considered with other information by the Executive Committee during the election process.

My employer is in support of my participation:
Please indicate the committee or workgroup you have been a member of in the last year:
Please indicate the number of All Partners meetings you attended in the past year:
I will support the Emergency Operations Plan of the Coalition and complete the program outcome objectives as detailed in the grant application and annual work plan:
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