Biographical Information Form 2018 ACMI Fellowship Nomination

To nominate an ACMI fellow, please complete the following information and upload the nominee’s photograph (TIFF or JPEG format, 150 dpi or less). As you submit information, click the “save draft” button from time to time so you do not lose information that you have already input.  The nominee’s biographical information and photo will appear on the ACMI online election ballot if he or she is selected for the ballot by the ACMI Elections and Nominations Committee.  This form is only for the ACMI Fellows nominations. If you are self-nominating for an ACMI Executive Committee position or an Election and Nominations Committee position, click here.

The deadline for submission of this information form and nominee’s photograph is June 18, 2018.

Nominators
Nominee
(50 words or less)
(100 words or less)
(100 words or less)
(50 words or less)
(50 words or less)
(250 words or less; include evidence of sustained contribution; for proposed Fellows from outside the United States, please summarize how the nominee's work has contributed to biomedical informatics in the United States)
(100 words or less)
(50 words or less)
Before you click the Submit Now button, please review your information carefully.