2024 CHEF/ACHE Regent Professional Achievement Awards Nomination Form

For full award descriptions, please visit the CHEF website.

For a summary of the awards and requirements, please visit the Awards Summary page.

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* 1. Nominee's Name

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* 2. Nominee's Title

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* 3. Nominee's Organization

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* 4. Nominee's Email Address

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* 5. Nominee's Phone Number

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* 6. Nominator's Name (if not a self-nomination)

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* 7. Nominator's Email Address (if not a self-nomination)

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* 8. Nominator's Phone Number (if not a self-nomination)

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* 9. Award Category (check one): Please check complete description and requirements on CHEF Website.

Healthcare Leadership Award (ACHE Member)

Career Achievement Award (ACHE Member)

Diversity, Equity, and Inclusion Award (1 Team Member Must be ACHE Member)

Health Studies Student/Administrative Fellow Leadership Award (ACHE Member)

Innovations Award (1 Team Member Must be ACHE Member)

Service Excellence Award (1 Team Member Must be ACHE Member)

Community Leadership Award (ACHE Membership NOT Required)

Young Healthcare Executive Award (ACHE Member)

2024 CHEF/ACHE Regent Professional Achievement Awards Nomination Form

Question Title

* 1. Nominee's Name

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* 2. Nominee's Title

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* 3. Nominee's Organization

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* 4. Nominee's Email Address

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* 5. Nominee's Phone Number

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* 6. Nominator's Name (if not a self-nomination)

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* 7. Nominator's Email Address (if not a self-nomination)

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* 8. Nominator's Phone Number (if not a self-nomination)

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* 9. Award Category (check one): Please check complete description and requirements on CHEF Website.

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* 10. Brief Description of Achievements/Initiatives:

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* 11. School/Program Attending or Location of Fellowship (Health Studies Student/Admin Fellow Leadership Award Only):

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* 12. GPA (Health Studies Student/Admin Fellow Leadership Award Only)

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* 13. For any team awards, please list the ACHE Member.

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* 14. List the nominee's extra-curricular healthcare activities.