Student Scholarship Application

Applicant Information

First
Last
mm/dd/yy
Primary Phone
Alternative Phone (optional)
Current Address/Residence
Primary Email
Scholarship Applying for *

Employment Information

Family Information

First
Last
Current Address/Residence

References

Reference letters should be sent directly to awards@khima.org by the person supplying the reference letter.
List two personal references (other than family, clergy) and provide their addresses.
First, Last
Street, City, State, ZIP Code
Primary Phone
First, Last
Street, City, State, ZIP Code
Primary Phone

Education Information

Please list the schools you have attended.

Post-High School Education - Attach Transcript (PDF Files Only) *
Maximum upload size: 2MB

Professional Experience

Write a brief summary of your professional/business experience.
Please list or describe any professional association activities you are apart of.
Please attach applicant letter explaining KHIMA Scholarship Guidelines item #2 line e. (PDF Files only) *
Maximum upload size: 268.44MB
Please attach proof of AHIMA membership, if applicable. (PDF Files only)
Maximum upload size: 268.44MB

Signatures

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.
First and Last
  • Applications must be submitted to Awards and Scholarships Chairman of KHIMA by May 31, 2021.
  • To be eligible for the scholarship, All candidates (undergraduate and graduate) must be residents of the state of Kentucky and be full or student members of AHIMA and have Kentucky designated as their component state association (CSA). Undergraduate students must be attending an 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 must serve on a KHIMA committee for a period of one year.
  • Incomplete applications will not be accepted.