AMIA Chair Elect Application | AMIA - American Medical Informatics Association

Eligibility

Please note: Applicants must be an active AMIA member.

Per AMIA Bylaws, Article 4, Section 3: Terms of office for the Chair, Secretary, and Treasurer shall be for two (2) years and for the Past Chair and Chair-elect one (1) year, beginning on the first day of the calendar year following their election. No person shall serve more than two (2) consecutive terms in any one officer position and must be no longer in position for at least 12 months before being eligible to again serve in that position. Prior AMIA Board experience is required to run for an officer position.

Article 4, Section 6: The Chair-elect shall automatically become the Chair at the conclusion of the term of the previous Chair.

First Name

Last Name

Email Address

Title

Organization

Education

Please note highest degree earned

How long have you been an AMIA member?

Less than 5 years

5-10 years

10-20 years

More than 20 years

AMIA Engagement and Participation

(participation in AMIA committees, working groups, etc)

Membership and Engagement

AMIA leaders are expected to have a track record of membership and engagement in the organization.

May we share your engagement data with the Nominating Committee for consideration in the selection of the slate?

Yes

Demographic Information

Gender

Race (check the race with which you identify)

White

Black or African American

Native Hawaiian or Pacific Islander

Asian

Native American or Alaskan American

Two or more races (select those that apply)

Prefer not to answer

Optional: Additional specifying data for ethnicity/race/nationality e.g. Middle East North African (MENA); Indian subcontinent

Ethnicity

Hispanic or Latinx (may be of any race)

Prefer not to answer

Experience

Have you previously nominated yourself for board service?

Yes

Have you previously served on the board?

Yes

Personal Statement / Short Biography

Please answer the following questions

Why would you like to serve as AMIA’s Board Chair?

Describe your leadership style. Provide one or more brief examples to illustrate your style.

Summarize your key leadership accomplishments within AMIA, focusing on results delivered in each role.

Summarize your key leadership accomplishments outside of AMIA, focusing on results delivered in each role.

How do AMIA’s goals and priorities align with your own? How would you manage conflicts?

Being Board Chair is a substantial time commitment (10-15% effort). Describe how you will make time to serve in this role.

Headshot

Upload your headshot

File name must include your full name.
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png.

Conflict of Interest

COI Agreement

I have completed my COI form (If you haven't completed the COI form, please complete the COI online form).

Date

Signature

Before you submit, please review your information carefully.