Raven EMS Education Program Manual
Public Member Bio Form

Advisory Committee public member qualifications: A public member is not employed as an EMS or healthcare provider; is not a member of any trade association or membership organization that is related to the practice of emergency medical services; is not eligible for another status; is not employed by the sponsor of the educational program; is not a relative of an individual who is employed by the sponsor of the educational program; and, does not hold any position with another accredited program.

Public member name:

Date of appointment:

Occupation (If retired, previous occupation):

Affirmation:

• No experience with or employed by an emergency medical services agency.
• No experience with or employed by a health organization as a clinician.
• Not related to any employee of the program.
• Not employed by the program.

Affirmed by: Date:
Clear

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