CPHIMA Scholarship ApplicationCPHIMA Scholarship Application Demographic Information First Name * Last Name * Credentials AHIMA Member ID * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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 File Maximum upload 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 File Maximum upload size: 268.44MB Please upload official or non-official transcript(s). Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Please list any awards or honors received. If you are human, leave this field blank. Δ
