IdHIMA Credentialing Exam Scholarship Application

The Idaho Health Information Management Association (IdHIMA) is dedicated to promoting Health Information Management (HIM) and assisting HIM specialists in their professional development. IdHIMA is, therefore, offering three (3) scholarships this year to go toward the fee for any AHIMA credentialing exam at the member rate. Both IdHIMA active status members and students are eligible to apply with the stipulation the credentialing exam must be taken by the allotted time documented on their scholarship award certificate.

INSTRUCTIONS:

If you would like to apply for an AHIMA credentialing exam scholarship, please follow the steps outlined below:

Step 1: Complete the application form.

Step 2: All applications will be reviewed by the IdHIMA Scholarship Committee. Three (3) applicants will be selected to receive the scholarships.

Step 3: After review of applications and selection of the scholarship recipients, all applicants will be notified as to the status of their request.

Step 4: Scholarships will be awarded at IdHIMA’s annual spring convention. All applicants are welcome to attend. A special invitation will be extended to the scholarship winners.

IdHIMA Credentialing Exam Scholarship Application

Applicant

Applicant Name

Address

Street Address

Address Line 2

City

State

Zipcode

Phone

AHIMA ID

Education

High Schools Attended

Colleges/Universities Attended

Degrees Received

If a graduating student:

Current Major

Overall GPA

Month & Year of Anticipated Graduation

Degree/Certificate Receiving

Have you personally financed your education?

Yes

AHIMA Credentialing Being Sought

Work Experience

Work Experience 1

Start Date

End Date

Employer

Duties

Work Experience 2

Start Date

End Date

Employer

Duties

Work Experience 3

Start Date

End Date

Employer

Duties

Activities & Interests

References

Reference Name (1)

First Name

Last Name

Relationship

Reference Address

Street Address

Address Line 2

City

State

Zipcode

Phone

Reference Name (2)

First Name

Last Name

Relationship

Reference Address

Street Address

Address Line 2

City

State

Zipcode

Phone

Reference Name (3)

First Name

Last Name

Relationship

Reference Address

Street Address

Address Line 2

City

State

Zipcode

Phone

Letter

Please write a letter outlining your reasons for applying for this scholarship, your post exam plans, and the contributions you plan to make to the health information management profession.

Certification

I certify that all the information provided on this application is true/correct. I hereby give permission to the Idaho Health Information Management Association (IdHIMA), and it representatives, to verify information contained in this completed scholarship application. I also authorize IdHIMA the right to release information, which is pertinent to this application, to others involved in providing funds related to my exam. I further authorize IdHIMA to include my name, when appropriate, in the list of winners to be posted on the IdHIMA Web page, and to be publicized in IdHIMA newsletters.

IdHIMA Credentialing Exam Scholarship Application

INSTRUCTIONS:

Applicant

Education

Work Experience

Activities & Interests

References

Letter

Certification

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