______

The information provided in this form will be used by the AHIA Nominating Committee to verify applicant qualifications and nominate candidates for the AHIA Board of Directors election to begin on Tuesday, August 29, 2017. This information, including the Candidate’s Statement and photo, will be presented on the ballot. ______

The Association of Healthcare Internal Auditors (AHIA) is an international organization dedicated to the advancement of the healthcare internal auditing profession, primarily through providing healthcare auditors with specialized education and networking opportunities. The nine-member Board of Directors, which includes the four executive officers, provides leadership in achieving this objective.

Board of Directors Election

TwoDirector-at-Large and one Executive Officer will be elected in 2018 election for the terms shown below. Please indicate the position for which you are submitting this application.

_____ Director (3-year term – 2018-2020) – Two available positions

_____ Executive Officer Track (4-year term - Secretary/Treasurer 2018, Vice Chair 2019, Chair 2020, Past Chair 2021) – One available position

______

please complete each section below

name
title
organization
city
state
telephone number
relevant work experience, include number of years
for each position
highest educational
degree earned
professional designations,
if applicable
number of ahia annual conferences attended
positions held in
ahiacommittees
(indicate whether past or present, and number of years served
in each position)
leadership positions held
in other professional associations
(indicate whether past or present, and number of years served
in each position)
CANDIDATE STATEMENT: describe personal qualities and accomplishments, supporting the reasons why you believe you are the best candidate to serve as a Board Member,
include examples
(75-word maximum)

applicant acknowledgment

I wish to be a candidate for election to AHIA’s Board of Directors. By my signature, I hereby recognize that the position applied for is a volunteer position and that I may not use such position for direct personal or employer benefit. My role, if elected, is purely to support and promote the mission of the Association of Healthcare Internal Auditors.

______

signaturedate

                   

Please complete, sign and returnthis formand return no later than May 31, 2017.

Your photo (in electronic format as a .tif or .jpeg file) should be sent

no later than August 1, 2017.Send completed form and phototo Michelle Cunningham at

Thank you!

                   

10200 W. 44th Street, Suite 304, Wheat Ridge, CO 80033

(303) 327-7546, ext. 6120 TOLL FREE: (888) 275-2442, ext. 6120 Fax: (720) 881-6101

Page 1 of 2