CPSA Council Nomination Form: Candidate Profile

Council election nominations are open May 1 - May 30, 2025!

CPSA Council election nominations are open May 1 – May 30, 2025 to fill 4 regulated member vacancies, for a 3-year term commencing January 2026.

How to submit your Council nomination

Learn about the role of a CPSA Councillor
Determine if you meet eligibility requirements:
- You do not hold a current role/position that could present as a conflict of interest,
- You are a regulated member in good standing with CPSA,
- You are in compliance with the Health Professions Act (HPA), and
- Your primary residence is Alberta.
  - Learn more about eligibility requirements
Complete the candidate nomination form and upload all supporting documents.

Important! All nomination forms and supporting documents must be submitted to us by May 30 at 11:59 pm MST.

If you experience any technical difficulties filling out this form, don’t hesitate to reach out to elections@cpsa.ab.ca

Candidate nomination form

"*" indicates required fields

Name*

First name(s) Last

Preferred name (if applicable)

CPSA registration number*

Primary practice location (city/town)*

Technical competencies

The Nomination Committee would like to know how candidates describe their proficiency in the following technical competencies. Expertise is neither mandatory nor expected. Understanding the technical proficiency of new and existing Councillors helps to ensure Council is balanced and well-equipped to support CPSA’s mandate. Please provide a rough self-rating of your experience and knowledge in the following technical competencies.

Descriptions:

N/a: I have no experience in this area.
Beginner: I have a cursory awareness, but little to no practice.
Intermediate: I am familiar and have some experience, but its not something I deal with day-to-day.
Advanced: This is something I have training in and utilize nearly everyday.
Expert: I have formal training and certification in this area.

Financial acumen

Technology and data management acumen

Human resource management

Diversity, equity, inclusion and anti-racism

Legal acumen

Physician References

Please appoint three regulated members in good standing with CPSA to act as references who we may call.

First regulated member's name*

First Last CPSA registration number

First regulated member's email*

Enter Email Confirm Email

First regulated member's phone number

Second regulated member's name*

First Last CPSA registration number

Second regulated member's email:*

Enter Email Confirm Email

Second regulated member's phone number

Third regulated member's name*

First Last CPSA registration number

Third regulated member's email:*

Enter Email Confirm Email

Third regulated member's phone number

Supporting documents

Please upload your resume and cover letter below in one document and address your cover letter to the CPSA Council Nomination Committee. Your resume and cover letter should detail the following:

Medical training and experience (years of experience, medical specialization and related interests)
Other professional designations or pursuits
Motivation for running, in relation to the core competencies/attributes.
Geographical areas within Alberta where you have resided and/or practiced.
Your personal or professional experience with marginalized or underrepresented groups within Alberta.

Upload your resume and cover letter*

Attached documents must be: doc, docx or PDF. Please do not password protect your files.

Accepted file types: doc, docx, pdf, Max. file size: 5 MB.

Contact email

CPSA will use your email to notify you that we received your completed form.

We may also use it, with your consent, to populate a website contact form during the election. This will enable individuals to ask you questions about your nomination and interest in running for CPSA Council.

Important: Individuals will only see your name on the contact form. They will NOT see your email address unless you decide to reply to their question/comment.

Email*

Enter Email Confirm Email