HIM Application
This application is for acceptance into one of the degree/certificate paths that fall under the Health Information Management Program
Email address *
Degree you are applying for? *
Required
How did you hear about us? If from an individual, please provide their name. *
Your answer
Your Full Name (First, Middle, Last) *
Your answer
Other Names Used
Your answer
Admissions Paragraph - Please let us know why you chose this career path and/or degree/certificate. What would make you a good fit for our program? *
Your answer
What are your future educational goals after completion of this degree/certificate? *
Your answer
Mailing Address *
Your answer
City, State, Zip Code *
Your answer
Student ID *
Your answer
Education: College 1 (List most recent first)
Your answer
College 1 City and State
Your answer
Education: College 2
Your answer
College 2 City and State
Your answer
Other Education
Your answer
Employment: Employer 1 (List most recent first) *
Your answer
Employer 1 City and State
Your answer
Dates of Employment
Your answer
Positions Held
Your answer
Employment: Employer 2
Your answer
Employer 2 City and State
Your answer
Dates of Employment
Your answer
Positions Held
Your answer
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