MoHIMA Scholarship Application
Page One
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1.
About the Applicant
First Name
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Last Name
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Street Address
City
State
Zip
Email Address
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Phone Number
*
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2.
Authorization
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I understand that this application will be reviewed by members of the Awards Project Team for the Missouri Health Information Management Association. I understand that the contents of this application will otherwise be kept confidential, but may be released for publicity purposes should I receive the award.