MNHIMA Distinguished Member Award Nominee Bio FormTo be completed by the nominee after the nomination is made.Distinguished Member Award Nominee Bio Form Nominee Name * Nominee Name Nominee Name Nominee Name Credentials AHIMA ID Number How long have you been a member of AHIMA? * Email * Phone Address Address Address Address Address Address StateAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Please upload a photo * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBNominator Name * Nominator Name Nominator Name Nominator Name Current Employment Job Title Company Name Supervisor's Name Supervisor's Email Supervisor's Phone Previous PositionsProvide job title and company name in reverse chronological sequence of positions held the last 10 years. EducationShow degrees earned, dates, names of college or university AHIMA Activities MNHIMA Activities Regional Association Activities Presentations and Other Professional ParticipationList presentations at meetings, conducting, coordinating, or teaching specialized seminars at local, state, and/or national level. PublicationsList all publications beginning with the most recent. TeachingList 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. SubmitMembersMembersAchievement AwardsMentoring ProgramScholarshipsUpdate Member ProfileVolunteer
