OkHIMA Rising Star Award Nomination Form

Part I: The Nominee

The Rising Star Award recognizes a promising newcomer to the field, who demonstrates exceptional motivation, capability, and leadership potential with great capacity for significant accomplishment in the field.

Note: 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.

1. About the Nominee

First Name *This question is required.

Last Name *This question is required.

Email Address This question requires a valid email address.

Phone Number

Present Employment Status

Place of Employment

Street Address

Individual Notified of Nomination? *This question is required.

2. Select the first commendable attribute you wish to discuss. *This question is required.
Please describe and provide examples in the comment box below about how the nominee meets the commendable attribute.

Comments *This question is required.

3. Select the second commendable attribute you wish to discuss. *This question is required.
Please describe and provide examples in the comment box below about how the nominee meets the commendable attribute.

Comments *This question is required.

4. Has the Nominee been in the HIM Profession for less than 10 years? *This question is required.

5. Other supporting information

6. Nomination submitted by

First Name *This question is required.

Last Name *This question is required.

Place of Employment

Email Address *This question is required.

Phone Number *This question is required.

Nominator's Signature *This question is required.

Clear

Signature of