Mark Dietz Rising Star Professional Nominee Bio FormTo be completed by the nominee after the nomination is made.Rising Star Professional Nominee Bio Form Nominee * Nominee Nominee Nominee Credentials AHIMA ID Number How long have you been a member of AHIMA? * Email * Phone Address Address Address Address Address Address State 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 Address Please upload a photo * Drop a file here or click to upload Choose File Maximum upload 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 Rising Star Professional 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
