CHIME Collaboration Award Submission Form

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Scholarships & Recognition

Scholarships & Recognition

CHIME Collaboration Award Submission Form

Entries due by Friday, July 18, 2008.

Entry Information (ALL fields required)

Title of Entry:
Executive Summary of collaboration and key points of entry:

Foundation Firm Information (ALL fields required)

Foundation Firm Name:
First Name:
Last Name:
Title:
Phone:	Fax:
Email:

CHIME Member Information (ALL fields required)

First Name:
Last Name:
Organization:
Title:
Phone:	Fax:
Email:

Who should be our primary contact regarding this entry:

Name:
Email:
If more than one CHIME Foundation Firm, CHIME Foundation Firm representative, or CHIME Member is part of this entry, please include additional information below:

You will be required to submit the entry paper and any supporting documents on the next page.

Questions or comments? Send an email to kcleary@cio-chime.org.

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The Healthcare CIO Boot Camp is built around a research-based model of CIO success pioneered by CHIME, called the CIO Success Factors. The CIO Success Factor model is founded on seven critical more more more

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Created in partnership with the American Hospital Association (AHA)

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