KHIMA Student Scholarship Education Enrollment Verification Form

Instructions to Applicant: After filling in your name in the appropriate blank, forward this form to the director of the health information management program in which you have been accepted.

Instructions to Program Director: The student named below has applied for a scholarship through the Kansas Health Information Management Association. In order to review the application, we must verify this student’s acceptance in an accredited health information management program or approved graduate program. If this student has been accepted in the final year of your program, please complete and sign this form.

KHIMA Student Scholarship Education Enrollment Verification

This verifies that the student named below is an applicant for a student scholarship award from the Kansas Health Information Management Association.

The student has been accepted for enrollment in the final year of the health information management/graduate program at the below named school.

The student is expected to complete his/her studies and graduate within the upcoming academic year. His/her overall cumulative GPA is (include the summer semester grades for HIA students and spring semester grades for HIT students):