IaHIMA Scholarship ApplicationIaHIMA Scholarship Application Demograhic InformationNOTE: All records of applicant will remain confidential and will be used only for the scholarship review and determination of applicant’s qualification.Name * Name Name Name AHIMA ID Number * Email * Phone * Phone (Cell) Street Address * City * State * Select ...AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip * Are You a United States Citizen? * Yes No Upload Your AHIMA Membership Card * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBAbout Your School/Program Name of School and Program * Street Address * City * State * Select ...AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip * Name of Program Director/Department Chairperson * Professional/Business ExperiencePlease describe your employment history below, including date of employment, employer, position held, and a brief description of your duties. A recent resume may be submitted here if available. Employment History * Upload Resume * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBEducational HistoryPlease describe below all post-secondary schools attended and degrees pursued and and/or achieved. Please note you may omit if included on your resume. Please upload the transcripts which include all credits earned. These transcripts must be official transcripts. Educational History * Upload Transcript(s) * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBOther Affiliations and AwardsPlease describe below any memberships you hold in professional organizations as well as awards and honors received. Other Affiliations and Awards Professional Goals Essay Why did you choose this career? * What do you think this profession can do for you? * What contributions do you feel you can make? * Why do you feel you deserve scholarship consideration? * ChecklistCheckboxes AHIMA Membership Card Attached Resume Attached Transcript(s) Attached Professional Goals Essay Questions Completed I will ensure the Educational Enrollment and Eligibility Verification Form is submitted by the Director of the Health Information Management Program, Department Chairperson, or Independent Study Program as appropriate for the program in which I am currently enrolled. I will ensure the Recommendation Forms for two persons I select as references are submitted. If you are human, leave this field blank. SubmitΔ
