CHIA Leadership Application

CHIA Leadership Application

Applications due Saturday, October 25, 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.

General Information
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)*
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

Professional Experience
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)*

Professional Experience
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

Reflective Responses
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?*

Document Uploads
Resume/Curriculum Vitae

Upload Resume/CV

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Headshot: CHIA includes photos in ballot announcements. Provide a hi-resolution, color photo in JPEG format.

Upload Headshot

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References
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.
Reference #1*

First NameLast Name
Reference #1 Phone Number*
Reference #1 Email*
example@example.com
Reference #2*

First NameLast Name
Reference #2 Phone Number*
Reference #2 Email*
example@example.com
Reference #3

First NameLast Name
Reference #3 Phone Number
Reference #3 Email
example@example.com
Reference #4

First NameLast Name
Reference #4 Phone Number
Reference #4 Email
example@example.com
Should be Empty: