Scholarship

First Name

Last Name

AHIMA Membership Number

Address

Address 2

City

State

Zip

Current Educational Institution

School

School Phone

Phone

Program Director

Program Director Email Address

Program Enrolled

Status

Begin Date Enrolled

mm/dd/yyyy

Expected Completion Date

mm/dd/yyyy

File Uploads

Please upload the following documents:

*You may upload in one PDF or separate uploads as appropriate.

Education History

List, in chronological order, all post-secondary institutions attended, including two-year and four-year colleges, universities, vocational, and professional schools.
* Include school name, state, field of study, attendance dates, degree, and year *

Transcripts

Copies of school transcripts are required from the three most recent post-secondary schools you have attended.

Reference Letters

Upload letters of recommendation from two references. References should include one educator and one personal or previous employer who can provide an evaluation of your professional and academic performance.

Essay

Type an essay of 500 words or less on why you feel you deserve this scholarship and how you intend to use the scholarship money. Discuss what personal attributes, training, experience or goals will make you an asset to the health information management profession.

File uploads

Ensure that all elements are uploaded properly.

Drop your files here

Attestation

Essay Attestation

Essay is solely my own, not written, composed, or edited by others.

Send me a copy of my responses

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