2018 KHIMA Rising Star Award If you are human, leave this field blank. Nominee Information Name * First Last Name * Last Job Title * AHIMA ID * Phone Number * Work Address * City * State * Alabama Alaska Arizona Arkansas 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 ZIP Code * Number of years in the HIM profession * Nominator Information Name * First Last Name * Last AHIMA ID * Email Address * Phone Number * Address * City * State * Alabama Alaska Arizona Arkansas 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 ZIP Code * Education Please list the nominee's education credentials. * Leadership Credentials * Awards/Recognitions * Leadership Roles * Reason for Nomination Please explain why you have selected this nominee. * Signature Nominator's Signature * Date * Application Deadline is May 15th, 2017.
