FCI Cohort 10 International Membership Application Form - Spring/Summer 2022

Please complete this FCI Membership form in full.

When completing the personal details and permission section of the application, when prompted, please tick ‘Yes’ if you are happy to give your permission and ‘No’, if not (see Q12-13 for details).

All personal details will be removed from your application before it is sent to the assessment panel. Your application will be anonymous, but could be identifiable via any specific experiences you describe or reference to publications that you provide.

For questions 14, 15 and 16 please ensure you provide dates wherever possible and avoid using acronyms unless the organisation is very well known (e.g. NHS). Refrain from using URLs and or links to social media accounts. Full guidelines regarding criteria and how to fill in your application (including example answers) can be found on our website.

If you require assistance in completing the form, please email info@fci.org.uk.

Question Title

* 1. Personal details and Permissions.

Title

First name

Surname

Address 1

Address 2

City

Zip Code/State

Postcode

Country

Email address

Telephone number

Mobile number

Question Title

* 2. Current job role(s)

Question Title

* 3. Organisation(s)

Question Title

* 4. Profession

Question Title

* 5. Professional registration body name

Question Title

* 6. Professional registration number

Question Title

* 7. Please attach scanned copies of documents that confirm both your professional registration and qualifications

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 8. If needed, please upload any further documents

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 9. Please confirm that you are currently in good standing with the professional registration body you have stated above. Please note this will be checked as part of your application process.

Yes

Question Title

* 10. Are you a current Member/Associate of the FCI?

Yes

Question Title

* 11. Organistational Memberships (e.g. MRCGP, BCS etc.)

Question Title

* 12. If approved for FCI membership, are you happy for your name to be shared on the Faculty website?

Yes

Question Title

* 13. If approved for FCI membership, are you happy for your details (name, profession, employer/role and membership of other organisations) to be included in a directory that can shared with other members? (This would not be available to non-members.)

Yes

Question Title

* 14. Areas of Interest e.g. AI, Genomics, Personalised Care, Language and Terminology

Question Title

* 15. Please describe your clinical informatics experience in the workplace (including start and finish dates).

In providing this description, you are encouraged to consider how your experience aligns with the six Domains of the FCI Core Competency Framework for clinical informaticians:

Domain 1: Health and Wellbeing in Practice
Domain 2: Information Technologies and Systems
Domain 3: Working with Data and Analytical Methods
Domain 4: Enabling Human and Organisational Change
Domain 5: Decision Making
Domain 6: Leading Informatics Teams and Projects

You can see the details of what is included within each Domain here, and also refer to the example descriptions in the applicant guidance notes available here.

Please also indicate whether your experience is at a local, national or international level. Particular weight is given to recognition at a national and international level when assessing applications for Fellow membership.

Please do not be concerned if you are not able to complete all six Domains. This is for guidance only to help you to draw out the breadth of your clinical informatics experience.

[Maximum 1000 words]

Question Title

* 16. Please describe your commitment to the advancement of clinical informatics as a professional discipline. This should include details of contributions that you have made both in your main role and/or any other projects you have worked on.

[Maximum 500 words]

Question Title

* 17. Declaration: I understand that if elected as a Member or Fellow I will be required to contribute an annual fee to the Faculty of Clinical Informatics. This is currently set at £102 per annum for Membership and £255 per annum for Fellowship. Other pricing options are available based on income.

FCI Cohort 10 International Membership Application Form - Spring/Summer 2022

Question Title

* 1. Personal details and Permissions.

Question Title

* 2. Current job role(s)

Question Title

* 3. Organisation(s)

Question Title

* 4. Profession

Question Title

* 5. Professional registration body name

Question Title

* 6. Professional registration number

Question Title

* 7. Please attach scanned copies of documents that confirm both your professional registration and qualifications

Question Title

* 8. If needed, please upload any further documents

Question Title

* 9. Please confirm that you are currently in good standing with the professional registration body you have stated above. Please note this will be checked as part of your application process.

Question Title

* 10. Are you a current Member/Associate of the FCI?

Question Title

* 11. Organistational Memberships (e.g. MRCGP, BCS etc.)

Question Title

* 12. If approved for FCI membership, are you happy for your name to be shared on the Faculty website?

Question Title

* 13. If approved for FCI membership, are you happy for your details (name, profession, employer/role and membership of other organisations) to be included in a directory that can shared with other members? (This would not be available to non-members.)

Question Title

* 14. Areas of Interest e.g. AI, Genomics, Personalised Care, Language and Terminology

Question Title

Question Title

* 16. Please describe your commitment to the advancement of clinical informatics as a professional discipline. This should include details of contributions that you have made both in your main role and/or any other projects you have worked on.

[Maximum 500 words]

Question Title

Question Title

* 18. Signed :

Question Title

* 19. Date:

FCI Cohort 10 International Membership Application Form - Spring/Summer 2022

Question Title

* 1. Personal details and Permissions.

Question Title

* 2. Current job role(s)

Question Title

* 3. Organisation(s)

Question Title

* 4. Profession

Question Title

* 5. Professional registration body name

Question Title

* 6. Professional registration number

Question Title

* 7. Please attach scanned copies of documents that confirm both your professional registration and qualifications

Question Title

* 8. If needed, please upload any further documents

Question Title

* 9. Please confirm that you are currently in good standing with the professional registration body you have stated above. Please note this will be checked as part of your application process.

Question Title

* 10. Are you a current Member/Associate of the FCI?

Question Title

* 11. Organistational Memberships (e.g. MRCGP, BCS etc.)

Question Title

* 12. If approved for FCI membership, are you happy for your name to be shared on the Faculty website?

Question Title

* 13. If approved for FCI membership, are you happy for your details (name, profession, employer/role and membership of other organisations) to be included in a directory that can shared with other members? (This would not be available to non-members.)

Question Title

* 14. Areas of Interest e.g. AI, Genomics, Personalised Care, Language and Terminology

Question Title

Question Title

* 16. Please describe your commitment to the advancement of clinical informatics as a professional discipline. This should include details of contributions that you have made both in your main role and/or any other projects you have worked on. [Maximum 500 words]

Question Title

Question Title

* 18. Signed :

Question Title

* 19. Date:

* 16. Please describe your commitment to the advancement of clinical informatics as a professional discipline. This should include details of contributions that you have made both in your main role and/or any other projects you have worked on.

[Maximum 500 words]