CHIA Student Scholarship Application

CHIA Student Scholarship Application
For more information about eligibility and full requirement details, visit http://californiahia.org/student-scholarships

Deadline for submitting applications (including the Application Form and all required documents) is March 1.
Name *

First Name Last Name
Credentials
AHIMA/CHIA ID Number *
CHIA Membership Status *

Student Member Graduate Member Active Member
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Email *
Name of College/University *
Name of HIA/HIT Program Course *
Expected HIA/HIT Program Graduation Date *

Month Day Year
GPA *
Transcripts *

Upload a File

Cancel of
Written Essay *

Upload a File

Cancel of
Recommendation Letters

Upload a File
Two (2) recommendation letters are required, and can be emailed directly. Cancel of
Program Director Validation

Upload a File
Program Director Validation is required, and can be emailed directly. Cancel of
I certify that the information submitted with this application is accurate and I authorize CHIA to validate its accuracy: *

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