DFW HIMA Scholarship Application

Contact Information

Name

Email

Phone

Street Address

Apt/Suite/Office

City

State

Zip

School Information

Name of School

Name of Program

Street Address

Suite/Office

City

State

Zip

Current Overall GPA

Enrollment Date

Expected graduation date

Please Upload the Following Documents with your Application

Verification form from Program Director

Maximum file size: 268.44MB

Transcript

Maximum file size: 268.44MB

Letters of Recommendation

Maximum file size: 268.44MB

Type of scholarship applying for:

Undergraduate

Graduate

List pertinent work experience including current employment, if applicable.

Dates of Employment

Employer

Position

Current Position

Current Position - Date

Current position - Employer

Current position

Past Position

Past Position 1 - Date

Past position 1 - Employer

Past position 1

Past Position

Past Position 2 - Date

Past position 2 - Employer

Past position 2

Past Position

Past Position 3 - Date

Past position 3 - Employer

Past position 3

Past Position

Past Position 4 - Date

Past position 4 - Employer

Past position 4

Organization Activities and Memberships – Professional

Organization Activities and Memberships – Personal (community, church, school, volunteer, personal interest)

Why did you choose the health information profession?

What are your short and long-term goals in the profession?

What contributions do you feel you can make to the health information profession?

DFW HIMA Scholarship Application

Contact Information

School Information

Please Upload the Following Documents with your Application

List pertinent work experience including current employment, if applicable.

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