HTM Leadership Award

PRO TIPS:

Please fill out the following form carefully and completely, noting all of the required fields.
All email addresses must be in valid xx@xx.xx format.
16 MB limit on all file uploads.
Your nomination is only submitted once you have reached a screen with a green top bar saying “Thank you for taking this survey”.
Files and supplemental materials may be emailed to awards@aami.org.
Please direct any questions or support needs to awards@aami.org.

Nominee Information:

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* 1. Nominee's Name:

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* 2. Title:

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* 3. Company/Affiliation:

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* 4. Mailing Address:

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* 5. Phone Number:

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* 6. Email Address:

Nominator Information:

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* 7. Nominator's Name:

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* 8. Title:

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* 9. Company/Affiliation:

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* 10. Mailing Address:

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* 11. Phone Number:

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* 12. Email Address:

Award Criteria: Nominees must meet all of the following:

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* 13. Nominee has an extensive record of leadership and accomplishment in the HTM field. Please describe:

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* 14. Nominee has made significant contributions to important issues facing the profession. Please describe:

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* 15. Nominee has demonstrated leadership in promoting the positive attributes of the profession, as well as demonstrated a professional commitment to the field by writing articles for industry publications, participating in committees, and speaking at industry events. Please describe:

Award Criteria: Nominees should meet the following:

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* 16. Nominee has demonstrated leadership in promoting the profession to the C-suite, clinicians, prospective students, and other healthcare professionals. Please describe:

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* 17. Nominee has shown evidence of HTM leadership and excellence at the workplace. Please describe in two sentences:

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* 18. Nominee has been a leader in a national, state or local HTM organization. Please list affiliated organizations:

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* 19. Nominee has been involved in a standards development process (such as AAMI, NFPA, JCR) or an individual’s own organization. Please list involvement:

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* 20. Nominee has made substantial contributions to AAMI. Please describe in two sentences:

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* 21. Nominator Cover Letter:

Upload nominator’s cover letter that provides a rationale statement describing the nominee’s accomplishments in the HTM field and leadership contributions to patient care, cost savings, or improvements in the use or impact of technology.