New Graduation Award Submission
Please complete the following information for your New Graduation Award recipient. Upon successful submission, you will be directed to the signature page. If you have any questions, please contact
Amy Dotts
, Executive Director.
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Response Required
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1. Name of Academic Institution:
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2. Name of Program Chair Submitting Award:
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3. Email Address of Program Chair:
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4. Name of Award Recipient:
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5. AHIMA Membership Number (award recipient):
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6. Email Address (award recipient):
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7. Mailing Address (award recipient):
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8. Telephone Number (award recipient):
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9. Date of Graduation:
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10. Certification Examination:
RHIA
RHIT
All checks will be made out to AHIMA and mailed to the award recipient. In the event that the recipient has already paid for the exam, OHIMA will reimburse the award recipient but a receipt of the exam purchase must be sent to OHIMA prior to payment.
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11. Payee Information:
AHIMA
Award Recipient (exam receipt must be provided)
12. Comments:
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