MHIMA Student Scholarship ApplicationMHIMA Student Scholarship Application Applicant InformationName * Name Name Name Address * Address Address Address Address Address StateAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address AHIMA Number Email * Name of School * Program Director Name * Program Director Name Program Director Name Program Director Name Program Director Email * Organizations: For the last five years, list any organizations & associations in which you have held any leadership roles to include board positions. Also list any organizations you are a current member of. Activities: List any activities you've been a part of within the HIM profession (e.g.: attendance at a national, state or regional HIM meeting, public speaking at any HIM functions, attendance at a student event day, etc). Community Service: List any community service activities (e.g.: service clubs, church activities, etc.) Honors, Awards and Recognitions: List any honors, awards, and/or recognition you've received during your college career (e.g.: Dean's list, President's list, Scholarships, Grants, Student of the Year, etc.). Student Essay In fewer than 250 words, address each of the following questions:Why did you choose HIM as a profession, and what impact do you hope to have?What have you learned about your ability to survive change in the past two years?Identify someone that has been an influential leader in your life and why? * Statement of Understanding: I understand the following:I authorize the release of my grade point average (GPA) by the Program Director of the college or university in which I am enrolled.The award may be received only once.This application will be reviewed by the MHIMA Foundation.The contents of this application will otherwise be kept confidential but may be released for publicity purposes concerning the recipients of the MHIMA Awards Committee.I authorize the release of my grade point average (GPA) by the Program Director of the college or university in which I am enrolled (HIT/HIM applicants only).The monies from the scholarship award will be used for educational costs for continuing in an accredited HIT/HIM program.My signature below indicates that I agree to the above statements and hereby acknowledge that the information in this application is true and correct. Please upload any documents here Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Signature * signature keyboard Clear Signature of * If you are human, leave this field blank. SubmitΔMembersAHIMA Awards ReceivedDistinguished Member AwardExam Reimbursement AwardJoin MHIMAMentor AwardScholarship AwardsStudent Achievement AwardStudent Concierge ProgramVolunteerBoard Responsibilities and DescriptionsUpdate Member Profile2017 AHIMA RACSO Award
