Student Ambassador Application Student Ambassador Application Instructions Letter of Recommendation Form (use this form to upload all recommendations) Applicant Information Name * First Last * Last Phone Number * Primary Phone Additional Phone Number Alternative Phone (optional) AHIMA Membership Number * Address * Current Address/Residence City * State ZIP Code * Email Address * Primary Email Employment Information Are you currently employed? * Yes No If Yes, Employer Employer 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 ZIP Code Employer Phone Employer Email Position Education Information College/University * Major * Program Coordinator * First Last * Last Email Address * Program Coordinator Email Phone * Program Coordinator or Department Phone Anticipated Graduation Date * Overall GPA * 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 ZIP Code * References List two references, other than family or clergy, along with their contact information. NOTE: One must be a HIM faculty member in the program which you are currently enrolled. Name * First, Last Email * Primary Email Phone * Primary Phone Name * First, Last Email * Primary Email Phone * Primary Phone Describe your professional/business experience. * List any professional association activities that you have been involved with. * In 1,000 words or less, describe why you're interested in particiapting in the ambassador program. * Transcript Upload(s) * Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Please upload a copy of your official or unofficial college transcripts (PDF Format Only). reCAPTCHA If you are human, leave this field blank. EducationEducation CAHIIM Accredited Programs Credentials Exam Reimbursement Distinguished Member Nomination Form MVP Nomination Form Outstanding Student Award Nomination Form Rising Star Award Nomination Form Speakers Bureau Student Ambassador Student Scholarship Student Scholarship Donation
