Distinguished Member Award Nomination Form

Thank you for nominating an individual for the MHIMA Distinguished Member Award. It is suggested that the group or individual nominating this candidate inform the nominee that they are proposing his/her name to guarantee that the information submitted is accurate.

MHIMA Distinguished Member Award

About the Nominee:

First Name

Last Name

Credentials

Title

Company

Address

Nominee's Email Address

Nominee's Phone Number

Nomination Submitted by:

First Name

Last Name

Credentials

Title

Company Name

Address

Email Address

Phone

Association Activities:

Organizations: For the last five years, list any regional, state or national organizations and associations in which the nominee has held leadership roles to include board positions.

Association Activities: List any association activities the nominee participated in or represented a regional, state or national role.

Community Service: List any community service activities (e.g.: church, service or other community activities)

Honors, Awards and Recognitions: List any honors, awards, and/or recognition the nominee has received during the past five years of their HIM career.

Letter of Recommendation:

The Distinguished Member Award is MHIMA's highest honor, awarding a member who's recognized by our association as having demonstrated exceptional service and leadership to MHIMA. In fewer than 250 words, please share why you feel this person deserves this honor.

Letter of Recommendation

Maximum file size: 268.44MB

Documents:

Document 1

Maximum file size: 268.44MB

Document 2

Maximum file size: 268.44MB

Document 3

Maximum file size: 268.44MB

Document 4

Maximum file size: 268.44MB

Document 5

Maximum file size: 268.44MB

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Distinguished Member Award Nomination Form

About the Nominee:

Nomination Submitted by:

Association Activities:

Letter of Recommendation:

Documents:

Members

2017 AHIMA RACSO Award

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