CPSA Council Nomination Form: Candidate Profile

Council election nominations are open Aug. 28 - Sept. 25, 2024!

CPSA Council election nominations are open Aug. 28 – Sept. 25, 2024 to fill 1 regulated member vacancy.

How to submit your Council nomination

  1. Learn about the role of a CPSA Councillor
  2. Meet eligibility requirements by:
    • Not owing fees, costs, fines, assessments, levies or any other sums to CPSA
    • Holding a valid and current practice permit that is not currently suspended
    • Complying with all orders or directions under the Health Professions Act
      Learn more about eligibility requirements
  3. Complete the candidate nomination form below, including:
    • The names of 3 regulated members in good standing with CPSA to endorse your nomination–they will be asked to complete a form confirming they are endorsing your nomination for election to CPSA Council
    • Your high-resolution, black and white head shot photo

Important! All nomination forms and endorsements must be submitted to us by Sept. 25 at 11:59 pm.

Candidate nomination form

"*" indicates required fields

Name*
Have you ever served on CPSA Council?*
Are you currently sitting on CPSA Council?*

Nomination endorsement

Please appoint three regulated members in good standing with CPSA to endorse your nomination for election to CPSA Council.
First regulated member's name*
First regulated member's email:*
Second regulated member's name*
Second regulated member's email:*
Third regulated member's name*
Third regulated member's email:*

Additional required documents

Attached documents must be: jpeg, jpg or png. Please do not password protect your files.
Accepted file types: jpg, png, jpeg, 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*

As a candidate running in CPSA's Council election:

As a candidate running in CPSA's Council election:*
As a candidate running in CPSA's Council election:*
As a candidate running in CPSA's Council election:*
As a candidate running in CPSA's Council election:*

Signature

Checking this box will act as your signature:*
MM slash DD slash YYYY

Help us improve our election process (optional)

Answering the following question will help us communicate future nomination and election information.
How did you hear about the nomination/election process? (Check all that apply)

CPSA's 2023 annual report is now available

See highlights from the past year and read accompanying stories online.