Kentucky HIMA Student Ambassador Application – Letter of Recommendation Applicant Information Applicant First Name * Applicant Last Name * Reference Contact Information First Name * Last Name Phone Number * primary phone number Additional Phone Number optional Current Address * Street Address City * State * Alabama Alaska Arizona Arkansas 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 ZipCode * Email Address * Primary Email Address What is your relationship to the student? * Faculty Member Former Supervisor Current Supervisor Colleague Other If "Other", please list the relationship. * Do you recommend the student for acceptance into the KHIMA Student Ambassador Program? * Highly Recommend Recommend Do Not Recommend Please upload your letter of recommendation in PDF Format only. * Drop a file here or click to upload Choose File Maximum upload size: 268.44MB If you are human, leave this field blank. Δ
