AAHIM Distinguished Member Award Nominee Bio FormAAHIM Distinguished Member Award Nominee Bio Form To be completed by nominee after the nomination is made.Please refer to the scoring criteria prior to completing this form.Nominee Name * Nominee Name First First Last Last Credentials AHIMA ID Number Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Email * Phone How long have you been a member of AHIMA? * Nominator Name * Nominator Name First First Last LastCurrent Employment Job Title Company Name Previous Positions Provide job title and company name in reverse chronological sequence of positions held the last 10 years. Education Show degrees earned, dates, names of college or university AHIMA Activities AAHIM Activities Regional Association Activities Presentations and Other Professional Participation - List presentations at meetings, conducting, coordinating, or teaching specialized seminars at local, state, and/or national level. Publications - List all publications beginning with the most recent. Teaching - List college/junior college instruction (specify subject area and approximate dates taught); adjunct faculty positions for HIM or other health programs; professional practice supervisor, etc.) Other professional association participation Other Contributions To Professional Or AHIMA "Image" Not Classifiable Elsewhere - Let your imagination flow! I hereby confirm that the information submitted on this nominee for the Distinguished Member Award is true and accurate to the best of my knowledge. * Clear If you are human, leave this field blank. SubmitΔ
