Legacy Chapter Award Submission

Submit legacy chapter award nomination

Legacy Chapter Award Submission

"*" indicates required fields

Award Selection*

Please select the award application

Is this a self-submission or are you nominating someone else?*

I am nominating myself for this award.

I am nominating someone else.

If self-nominating, please be sure to include your CV/Resume. If nominating on behalf of someone else, CHIMA will reach out to the nominee to collect their CV/Resume. Nominees will be evaluated by an independent review team and eligibility will be determined based on a combination of professional, educational, and community experience as it applies to Health Information."

Nominator

Nominator First Name*

Last name*

Nominee Information

The person that will receive the award should they be successful

Nominee first name*

Nominee last name*

Nominee Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominee phone number*

Nominee email address*

Award submission

Resume or CV

Accepted file types: pdf, doc, jpg, Max. file size: 5 MB.

If you have a CV, Linked In Profile or resume for the individual please upload it.

Specify why you feel the nominee deserves an award*

500 character limit

Terms and conditions

CAPTCHA

Submit legacy chapter award nomination