GHIMA | Georgia Health Information Management Association | Established Professional Award Nomination Form

To nominate someone for a GHIMA Award, click here.

The Georgia Health Information Association’s Established Professional Award is designed to provide opportunities for Active GHIMA members to attend GHIMA and AHIMA-sponsored educational programs in those instances when the member would not otherwise be able to attend due to financial limitations. Active GHIMA members are eligible to apply for the Established Professional award.

Established Professional Awards may be approved for educational program registration fees, travel and lodging to attend the program. Qualified educational programs are GHIMA and AHIMA-sponsored programs including GHIMA and AHIMA Annual Meetings, Seminars, and Workshops. Members are encouraged to apply for funds to cover the expenses as needed. However, the funds approved may be for all or a portion of the requested amount. Travel and lodging will be considered for reimbursement if the educational program location exceeds 100 miles from member’s home. Lodging is considered for shorter distances if the program is more than one day in length.

All applications from qualified applicants will be considered. In selecting the recipients, consideration will also be given to the member’s level of commitment to the Health Information Management field as demonstrated by participation in professional activities and volunteerism at the local/state/national level. The GHIMA Board shall have sole discretion in approving requests for Established Professional Awards.

Eligibility: Any Active, Credentialed member of GHIMA is eligible to apply. Active members are eligible to apply for an Established Professional award if they have not received a the award to attend any GHIMA or AHIMA program previously.

Deadline dates: Your application may be submitted any time during the year, but must be received by GHIMA at least 30 days prior to the date of the educational program you wish to attend.

Active Member’s Name		Credential(s)	AHIMA #:
Address		City State Zip
Employer
Position			How long?
Home Phone	Work phone		E-mail

I am requesting the Established Professional award for the following expenses. (complete the information only for the categories of expenses being requested.)

Program I wish to attend	Date of program	Location of program

Registration fee:			$
Ground Transportation at IRS rate: Number of miles Roundtrip: From: To:			$
Coach Air Transportation: From Airport: To Airport:			$
Total Lodging Expense: At Hotel: Number of nights:			$
Total Meals expense:			$
Total GHIMA Established Professional Award Amount Requested			$

I want to attend this program because:

I would like approval for GHIMA Established Professional Award to attend this program because:

My attendance at this program will help me in my current position and/or help me attain my professional goals in the following way:

I have received the following funds (to attend educational programs) from my regional association or GHIMA within the past two years: (please list, if any)

I will receive the following funds from other sources to attend this program (list funds you will receive from your employer, your regional association or other sources to attend this program):

My involvement in Health Information Management professional activities/committees at the national, state, and/or local level include:

List date, activity, and organization