WSHIMA Foundation ScholarshipWSHIMA Long Term Care Health Information Management Scholarship Demographic Information First Name * Last Name * AHIMA ID Number * Email * Phone * Street Address * Apt/Suite/Office City * State * Zip * Are you a legal resident of Washington State? * Yes No College Attending * Program Attending * Year in Program * Are you in your final year of your program? * Yes No Planned Graduation Date * What is your current or future HIM work plans? Please provide any statement of financial need. * Have you worked or do you plan to work in a long-term care or skilled nursing facilty? * Yes No Where? Most recent unofficial program transcript. * Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Professional Letter of Reference * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBAttestation * I hereby certify the information provided by me on this application is true and correct to the best of my knowledge. I agree to the conditions outlined above. If you are human, leave this field blank. Submit
