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Self Nomination

Open Positions

Please note highest degree earned
How long have you been an AMIA member?
(participation in AMIA committees, working groups, etc)

Demographic Information

Race (check the race with which you identify)


Leadership Skills

Working Group leaders are expected to think strategically and analytically and be able to effectively communicate their thoughts and the reasons for them. A demonstrated understanding of the differences between oversight and supervision is also desired.

Perspective Add

To support diversity and inclusion in our organization we are looking for perspectives or lived experiences not reflected on the current AMIA Working Groups.  We hope to bring new or important perspectives that are underrepresented (demographic diversity/institutional/corporate/focus area diversity).

Committed AMIA Member

Working Group leaders will have a demonstrated familiarity with AMIA, its mission, vision, and core values.

Personal Statement


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


I agree with the terms and conditions.
I have completed my COI form (If you haven't completed the COI form, please complete the COI online form.
Before you submit, please review your information carefully.