Distinguished Member Award Form

Applications must be submitted no later than February 28, 2022.  Please note that you will have the ability to save the application and return to work on it again at a later time.

Consideration Requirements:

  1. At least one (1) letter of recommendation from the sponsoring individual or regional association completing this application.  You will have the ability to upload the letter when completing the application.
  2. Two (2) additional references.  You will have the ability to upload the references when completing the application.
  3. Resume or Curriculum Vitae for the Nominee. You will have the ability to upload the resume/CV when completing the application.
  4. Full completion of the Nomination Form.

NOTE: It is necessary that the nomination form be completed in its entirety to provide the Executive Board with the information needed to assess the Nominee’s qualifications for the Distinguished Member award. The individual or regional association submitting the nomination may do so without informing the Nominee if all data necessary to adequately describe the Nominee’s achievements are available.

PHIMA Distinguished Member Nomination Form

About the Submitter

Nomination Submitted By
Submitter Name
Submitter Name

About the Nominee

Nominee Name
Nominee Name

Letter of Recommendation

Maximum upload size: 268.44MB

References

Maximum upload size: 268.44MB
Maximum upload size: 268.44MB

Resume

Maximum upload size: 268.44MB

Employment

Present Employment Status

Association Activities

Identify the association by name and list most recent activity first, including dates in each category.

Contributions to the Profession