KHIMA Distinguished Member NominationKHIMA Distinguished Member Nomination Nominee InformationName * Name Name Name Email * Phone * Address * Address Address Address Address Address StateAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Years in HIM * Job Title (most recent or highest earned) * Highest Degree Earned Additional licenses or certifications Nominator InformationName * Name Name Name AHIMA ID Number * Email * Phone * Address * Address Address Address Address Address StateAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Leadership Roles Local Level * State Level * National Level * Other Affiliated Associations Impact on HIM Publications Teaching in AHIMA Approved Education Programs Other HIM Instructions Other Contributions to Professional "Image" Not Classified Elsewhere Other Contributions Reason for Nomination Why have you chosen to nominate this member for the distinguished member award? Please provide a well written statement that is at least one paragraph and responds to the following questions:How has the member demonstrated strong leadership skills?How has the member shown integrity in their work?How has the member gone above and beyond to impact the HIM profession? * Signature * Clear Signature of * Date * If you are human, leave this field blank. SubmitΔ
