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* 1. RACS ID

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* 2. First Name

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* 3. Surname

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* 4. Specialty

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* 5. Are you a Fellow of RACS (FRACS)?

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* 6. If required, are you willing to travel?

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* 7. Have you been faculty before with RACS? If so which course(s)?

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* 8. Have you completed the Operating With Respect face to face Course?

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* 9. Have you completed the Foundation Skills for Surgical Educators Course?

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* 10. Are you a current/recent (last 5 years) Surgical Supervisor?

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* 11. If yes, please detail experience (max 500 words):

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* 12. Are you a current/recent (last 10 years) Board chair?

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* 13. If yes, please detail experience (max 500 words):

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* 14. Why are you interested in joining the Faculty of the Difficult Conversations with Underperforming Trainees course? (max 500 words)

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* 15. What qualities do you think are important for Surgical Faculty teaching the Difficult Conversations with Underperforming Trainees course? (max 500 words)

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* 16. Please outline your experience in managing underperforming Trainees? (max 500 words)

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* 18. Your Privacy: RACS is collecting the information on this form for the purpose of processing your course registration.  This information may be disclosed to those responsible for the administration and conduct of the course including external parties who provide administrative and organisational support.  The College may also need to verify the information provided on this form with external institutions or individuals, and gather additional information in order to process your registration. We may also disclose personal information where we are required to do so by law.  If you fail to provide this information the College will be unable to process your registration. You may gain access to the personal information you have provided on this form and other personal information we hold about you by contacting the College’s Privacy Officer on 03 9249 1200. You also have the right to update and correct any personal information we hold about you.

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* 19. By completing this form you are agreeing:
- To be a RACS Faculty for the above mentioned course/training for the agreed term of 1 year;
- That you have read the relevant policies 
- That you agree with the privacy information in Q18
and you wish to proceed with your EOI.

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