AAMI's Young Professional 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 the screen with the 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 is committed to being a positive role model for the profession and peers. Please describe activities:

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* 14. Nominee is currently under the age of 40. Please list the nominee’s year of birth:

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* 15. Nominee has been employed in the healthcare field for three years or more. Please note "yes":

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* 16. Nominee demonstrates a commitment to the advancement of the profession by writing articles, participating on committees, and/or speaking at industry events. Please describe:

Award Criteria: Nominees should meet the following:

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* 17. Nominee actively participates with AAMI and/or other local, state or national organizations. Please list the affiliated organizations:

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* 18. Describe specific examples of professional leadership that the nominee has demonstrated:

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* 19. Nominator Cover Letter:

Upload nominator’s cover letter that provides a rationale statement describing the nominee’s exemplary professional accomplishments and dedication to the health technology profession, highlighting published work and committee involvement.