OkHIMA Rising Star Award Nomination Form

OkHIMA Rising Star Award Nomination Form

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.

Part I: The Nominee

Name
Name
First
Last
Present Employment Status
Address
Address
City
State/Province
Zip/Postal
Individual Notified of Nomination?
Has the Nominee been in the HIM Profession for less than 10 years?

Part II: The Submitter

Name
Name
First
Last