Spirit of AAMI 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 demonstrates a commitment to AAMI. Please describe:

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* 14. Nominee has a long record of volunteer service with AAMI. Please describe known contributions:

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* 15. Nominee has demonstrated leadership by identifying and working with AAMI to resolve a challenge facing the field. Please describe leadership:

Award Criteria: Nominees should meet the following:

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* 16. Nominee has been a leader on AAMI committees. Please list affiliated committees:

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* 17. Nominee has a proven record in helping bring together diverse stakeholders to forge consensus and improve patient safety. Please describe:

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* 18. Nominator Cover Letter:

Upload nominator’s cover letter that provides a rationale statement describing the nominee’s commitment to AAMI, and how the nominee has advanced AAMI’s mission and strategic goals, as well as ways in which the nominee has helped bring together diverse stakeholders to forge consensus and improve patient safety.

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