SHS/HIMSS Excellence in Healthcare Management
Engineering/Process Improvement Award
For 2008 Awards Program
April 2009 – Chicago, IL
NOMINATION FORM
Name:
Title:
Organization:
Address:
City:
State:
Phone:
Fax:
Zip:
e-mail:
Please answer the following questions:
1. What year did the applicant SHS?
HIMSS?
join:
2. Describe professional or organizational activities as a member
a. of SHS ___________________________________________________________________________
__________________________________________________________________________________
b. of HIMSS _________________________________________________________________________
__________________________________________________________________________________
3. In addition to the completed application form, the following items must be supplied for each nominee in order for
them to be considered for the Award:


A current resume or biographical profile
A description of how the nominee meets the following Award criteria:
 Has demonstrated innovative and effective synergies in the profession of management engineering
and/or process improvement
 Has advanced the professional societies of SHS and/or HIMSS