MNHIMA Scholarship Application

NOTE: All records of applicants will remain confidential and will be used only for MNHIMA Scholarship Committee’s review and determination of applicant’s qualifications.

Scholarship Applicant

Applicant Name

First Name

Last Name

Applicant Address

Street Address

Address Line 2

City

State

Zipcode

Applicant Email

Applicant Phone

AHIMA ID Number

School Information

School Name

School Advisor

School Advisor Email

Cumulative GPA

Level of Program

Associate

Bachelor

Master

PHD

History of Professional Experience

Employer #1

Date of Employment

Employer #2

Date of Employment

Employer #3

Date of Employment

Organizational Activity

Please describe professional association activity. (Honors/Awards/Volunteer Activities/etc.)

Documents

Attach Your Transcript

Maximum upload size: 268.44MB

Attach Your Letter of Recommendation

Maximum upload size: 268.44MB

Reason(s) for choosing HIM as a career and an outline of your career goals.

Please describe your reason(s) for choosing HIM as a career and an outline of your career goals.

Contribution that you can make to the profession.

Please describe contribution that you can make to the profession.

Reason for applying for the scholarship fund.

Please describe your reason for applying for the scholarship fund.

Please confirm the following

I certify the above information is true and correct.

Release of Information

I hereby authorize release of all information necessary to process this application.

I agree to maintain student membership in AHIMA.

I agree

Should I not complete the educational program, I agree to reimburse MNHIMA the amount of the scholarship.

I agree

MNHIMA Scholarship Application

Scholarship Applicant

School Information

History of Professional Experience

Organizational Activity

Documents

Reason(s) for choosing HIM as a career and an outline of your career goals.

Contribution that you can make to the profession.

Reason for applying for the scholarship fund.

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