CHIA Leadership Application

CHIA Leadership Application

Applications due Monday, November 3, 2025
Nominations for the CHIA Board of Directors and CHIA Delegates to AHIMA are now being accepted. Refer to the CHIA Elected Leadership Opportunities webpage to learn more about these positions, duties, qualifications, and more.

Complete each section of this form to apply for a elected position. Please note, the application details provided will be used by the CHIA Nominating Committee for blinded deliberation. If selected for candidacy, select details will be used in ballot annoucements as provided.

This form can be edited by the user by saving the report progress. To utilize this feature, user must provide a response for all required questions and select "Save & Return" at the end. There will be an option to copy the link or send an email to the provided user email address and includes a copy of the responses and a unique link to edit the submission.
- Nominee's Name*
  
  First NameLast Name
- Credentials*
- AHIMA/CHIA ID Number*
- CHIA Member Type*
  Must be an active CHIA member to be eligible
- Email (Primary)*
- Phone (Primary)*
  Format: (000) 000-0000.
- Position Nominating For*
  
  CHIA President-electCHIA DirectorCHIA Delegate to AHIMA House of Delegates
- Will you able to serve a two-year term as CHIA Delegate to AHIMA?*
  
  YesNoNot sure
- Will you able to serve a three-year term as CHIA Director?*
  
  YesNoNot sure
- Provide at least two relevant health information practitioner positions. List most current first, descending order. (FORMAT: Position, Employer, Year Range EXAMPLE: HIM Director, ABC Coding, 2016-Current)*
- Provide academic and professional degrees or training received, including name of HIA or HIT school(s) and other schools attended, as appropriate. List most current first, descending order. (FORMAT: Degree/Training, Provider/School, Year Received EXAMPLE: Master's Degree: Strategic Leadership, ABC University, 2016)*
- Have you previously served on the Board of Directors for AHIMA, CHIA, other Component Association (CA), or Component Local Association (CLA)?*
  
  YesNo
- Provide position and term dates in this order: AHIMA, CHIA, CLA. List most current first, descending order. (EXAMPLE: AHIMA, Director, 2022-23)
- Have you previously served on any other Board of Directors (i.e. religious organization, schools, volunteer organizations, other)?*
  
  YesNo
- Provide position name of organization and years of service. (Example: March of Dimes, PTA; 1999-2021 )
- Have you served on committees and/or task forces for AHIMA, CHIA, other CA or former CLA?*
  
  YesNo
- Provide committee/task force role and term dates in this order: AHIMA, CHIA, CLA. List most current first, descending order. (EXAMPLE: CHIA Seminars Committee, Member, 2019-20)
- Are you a member of any other professional association/organization (i.e. HIMSS, AAPC, etc)?*
  
  YesNo
- Provide other association/organization role/activity and term dates. List most current first, descending order. (EXAMPLE: AAPC Coding Committee, Member, 2019-20)
- Are you active in any other volunteer roles with other associations/organizations (i.e school, church, community groups)?*
  
  YesNo
- Describe your volunteer role/activity in these other associations/organizations.
  
  0/100
- Have you published an article in a professional journal?*
  
  YesNo
- List recent published article (FORMAT: Title, Date, Topic, Publication)
- Have you prepared and presented a presentation to a professional association?*
  
  YesNo
- Describe the last presentation you gave (topic, location, audience) how you developed the material and what you/your audience learned from the experience.
- Have you completed more than five presentations in your career?*
  
  YesNo
- How have you mentored an HI professional and how are they are contributing to the profession and the association?*
  
  YesNo
- Describe your mentorship role and activities.
  
  0/100
- Describe a situation that exemplifies how you lead teams/projects*
  
  0/100
- Describe how the Health Information (HI) profession can adapt and change to address a particular healthcare issue/initiative. *
  
  0/100
- What makes you uniquely qualified to serve as President-elect for CHIA?*
  
  0/100
- What makes you uniquely qualified to serve as Director for CHIA?*
  
  0/100
- How do you advocate for the Health Information (HI) profession?*
- Resume/Curriculum Vitae
  
  Upload Resume/CV
  
  Cancelof
- Headshot: CHIA includes photos in ballot announcements. Provide a hi-resolution, color photo in JPEG format.
  
  Upload Headshot
  
  Cancelof
- Please be aware that a reference request will be automatically sent via email. Kindly ensure that you have informed the individual in advance and they may need to check their junk/spam folder for the email. Please note that memebers currently serving on the CHIA Board of Directors or the Nominating Committee are not eligible to provide a reference.
- Reference #1*
  
  First NameLast Name
- Reference #1 Phone Number*
  Format: (000) 000-0000.
- Reference #1 Email*
  example@example.com
- Reference #2*
  
  First NameLast Name
- Reference #2 Phone Number*
  Format: (000) 000-0000.
- Reference #2 Email*
  example@example.com
- Reference #3
  
  First NameLast Name
- Reference #3 Phone Number
  Format: (000) 000-0000.
- Reference #3 Email
  example@example.com
- Reference #4
  
  First NameLast Name
- Reference #4 Phone Number
  Format: (000) 000-0000.
- Reference #4 Email
  example@example.com
- Should be Empty: