CPHIMA Scholarship ApplicationCPHIMA Scholarship Application Demographic Information First Name * Last Name * Credentials AHIMA Member ID * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Daytime Phone Number * School Name * School Phone Number * Program Enrolled * HIM Associate HIM Baccalaureate Graduate Independent StudyEnrollment Status * Full-time Part-time Date Studies Began * Expected Graduation/Completion Date * Education History Please list in chronological order any other post-secondary institutions attended, including 2-year and 4-year colleges, universities, vocational, and professional schools. Include school name, field of study, attendance dates, and degree. Please upload a letter of recommendation. Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Please upload an essay describing your personal career goals and commitment to HIM field. Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Please upload official or non-official transcript(s). Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Please list any awards or honors received. If you are human, leave this field blank. Δ
