MHIMA Mentor Award Nomination FormThank you for nominating an individual for the MHIMA Mentor Award.MHIMA Mentor Award Nomination Form Part 1 - The Nominee First Name * Last Name * Credentials Title * Company * Address * Address Address Address Address Address StateAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Nominee's Email Address * Nominee's Phone Number * Part 2 - The NominationThe Nomination submitted by: First Name * Last Name * Credentials Title Company Name Address * Address Address Address Address Address StateAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Email Address * Phone * Part 3 - Supporting Materials Mentoring Activities: List up to ten (10) specific mentoring activities the mentor has provided to include providing clinical site supervision for students, participating in panel presentations or advisory committees, serving as an AHIMA mentor, etc. * Encouragement of the Future of HIM: List up to ten (10) specific ways this individual has encouraged new professionals to become involved in regional, state or national roles and how they've supported those efforts.(Required) * Fostering Motivation & Enthusiasm: List up to ten (10) specific examples of how the mentor fostered motivation and enthusiasm for the profession.(Required) * Letter(s) of support from others who have been mentored by the nominee:Attach up to five (5) additional letters of recommendation. The letters should include, in fewer than 250 words, how the nominee has served as a mentor and guided them towards professional excellence. Letter of Support 1 Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Letter of Support 2 Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Letter of Support 3 Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Letter of Support 4 Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Letter of Support 5 Drop a file here or click to upload Choose File Maximum upload size: 268.44MB If you are human, leave this field blank. SubmitΔMembersAHIMA Awards ReceivedDistinguished Member AwardExam Reimbursement AwardJoin MHIMAMentor AwardScholarship AwardsStudent Achievement AwardVolunteerBoard Responsibilities and DescriptionsUpdate Member Profile2017 AHIMA RACSO Award
