Kentucky HIMA Student Scholarship ApplicationKentucky HIMA Scholarship Application Part I: Applicant Information First Name * Last Name * Type of Student * HIM Baccalaureate Student HIM Associate Student Graduate Student Phone Number * Email * Street Address * Apt/Suite/Office City * State * Zip * Member of KHIMA? * Yes NoKentucky Resident? * Yes No AHIMA Membership Number Part 2: Current Education Institution Name of School * Name of Academic Program * Name of Program Director * Program Director Email * Anticipated Date of Graduation * Transcript Upload Area (PDF Files Only) * Drop a file here or click to upload Choose File Maximum upload size: 268.44MBPart 3: References Please upload two letters of recommendation from health information management professionals.(Letters from friends or relatives are not acceptable) * Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Letter of Good Standing (undergraduate applicants ONLY) * Drop a file here or click to upload Choose File Maximum upload size: 268.44MBPart 4: Professional Information Reason for choosing HIM as a career. * Contributions I can make to the profession. * Summary of leadership or professional activities (e.g. attendance at HIM association meetings, service on HIM association committee(s), employment in an HIM department, participation in a student HIM association, leadership roles in school/community activities or organizations). * Signature I agree to maintain student membership in AHIMA. Should I not complete the education program, I agree to reimburse KHIMA the amount of the scholarship. By clicking the "Submit" button below, I hereby certify that all the information I have given is accurate to the best of my knowledge.Applications must be submitted to Awards and Scholarships Chairman of KHIMA by May 12, 2023.To be eligible for the scholarship, all candidates (undergraduate and graduate) must be residents of the state of Kentucky and be members of AHIMA with Kentucky designated as their component state association (CSA). Undergraduate students must be attending a CAHIIM accredited HIA/HIT program. Graduate students must be enrolled in a program related to healthcare which will help advance the student’s career in healthcare.Scholarship recipients are encouraged to give back to the association by serving on a committee for one year following graduation. * Clear If you are human, leave this field blank. SubmitΔ
