Please see the form below to nominate for a committee. Each question relates to one or more selection critiera. Please read the selection criteria and the guiding questions in the boxes below before you write your answer. 



Your nomination form will not be assessed on your writing skills. The information in your answer is much more important than how you say it. Please don’t hesitate to contact the office if you have any questions or concerns about nominating for a committee.


For further guidance on how to complete the nomination form, please see here: 

Committee Nomination Form Guide
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For Frequently Asked Questions about the nomination process, please see here:

Committee Nominations FAQ
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To view the Selection Criteria, please see here:  

Selection Criteria for Committee Endorsements
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Committee Nomination Form
  1. Name(Required)
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  2. Address
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  3. Email address(Required)
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  4. Name of Committee(Required)
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  5. What experience of health services or interest do you have in the area of health related to this committee? (Required)
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  6. What do you think the consumer issues are in the area of health related to this committee?(Required)
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  7. How would you ensure that the consumer perspective you would bring to this committee reflected broad and accurate consumer viewpoints and experiences, and not simply your own views? (Required)
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  8. Are you able to work collaboratively with a range of people with different viewpoints, including consumers and service providers? Please provide an example of when you have done this.(Required)
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  9. Can you provide an example of when you used your oral communication and negotiation skills to effectively contribute to a discussion? (Required)
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  10. Have you received consumer representative training delivered by HCCA or another consumer organisation? (Required)
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  11. If you answered yes to the previous question, which organisation did you receive training from and in approximately what year did you complete the training?
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  12. Are you a financial member of HCCA? (Required)
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