WSHIMA Certification Exam Fee Reimbursement

Personal Information

Please complete the following demographic information:

Name

Credentials

AHIMA ID Number

Street Address

Apt/Suite/Office

City

State

Zip

Email

Phone

Educational Information

College/University Name

Name of Program

Date you graduated/completed Program

Date you passed the certification exam.
You must take the exam within twelve (12) months following graduation/official completion of the HIT or HIA program.

Required Documentation

Scan and upload the following documentation.

Provide proof of payment for the exam.

Maximum file size: 268.44MB

Written documentation showing your exam date and that the exam was successfully passed.

Maximum file size: 268.44MB

Additional Documentation (not required)

Scan and upload the following documentation.

Proof of any delayed scheduling — showing date scheduling done & date of exam

Maximum file size: 268.44MB

Acknowledgment

By signing my name in the following signature field, I certify that the information submitted with this application is accurate and I authorize WSHIMA to validate its accuracy. I consent to having my name posted on the WSHIMA website announcing the winners of the blind draw.

Signature

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