HIM Online Application : Health Information Management Program : Texas State University

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HEALTH INFORMATION MANAGEMENT PROGRAM
APPLICATION FOR PROGRAM ADMISSION
TEXAS STATE UNIVERSITY-SAN MARCOS

DUE NO LATER THAN MARCH 1st (early submission is encouraged)
We are no longer accepting HIM Applications for Fall 09, unless you have already been accepted by TxState University Admissions

All information must be completed as indicated. Two Reference Forms will also need to be submitted separately.

I am applying for admissions to the: *

Campus-based HIM Program

On-line HIM Program

Semester anticipate enrolling at TxState? *

Name: *

Current Date: *

Texas State Student ID# or SSN# (For transcript retrieval purpose only) *

Present Address: *

Permanent Address: *

Local Phone: *

Work Phone: *

Home Phone: *

E-mail: *

COLLEGES ATTENDED (most recent first) Include: Name, City/State, Date, Major, Degree Completed *

Are you an RHIT? *

Yes

No

Do you have any other professional credentials? *

Other healthcare related training? *

List honors and activities (college): *

List the names of scholastic and professional organizations of which you are a member: *

List the names of volunteer organizations of which you are a member: *

EMPLOYMENT: (List your present or most recent job first) Include: Employer, Dates, Type of Work, Reason for Leaving *

Are you attending college now? *

Yes

No

Where are you attending college?

Courses currently enrolled (Spring semester): Include course number and course title. *

Courses anticipating taking (Summer semester): *

THE FOLLOWING QUESTIONS MUST BE ANSWERED FOR APPLICATION TO BE COMPLETE.

Answer these questions in your own words. Your responses will be evaluated according to how clearly you express your own thoughts and your understanding of the health information management profession.

1-2 paragraphs for each question should provide a sufficient response.

QUESTIONS:

1. Describe what you perceive to be the major responsibilities of a health information professional. *

2. What influenced your decision to choose this as a major and why do you feel you are suited to the HIM profession? *

3. List your strengths and weaknesses and explain how they will assist you as a health information management professional and in achieving your career goals. *

RELEASE STATEMENT

I hereby certify that I have made no willful misrepresentations nor have I withheld information pertinent to this application. I authorize the Texas State University Registrar's Office to release copies of my transcript to the Health Information Management Program Admissions Committee. I understand acceptance by Texas State University does not imply acceptance into the professional phase of the Health Information Management Program. The HIM Program Admissions Committee will review and select students for entry into the program.

I am in agreement with the release statement. *

Yes

No

College of Health Professions

Health Information Management Program

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HIM Online Application

THE FOLLOWING QUESTIONS MUST BE ANSWERED FOR APPLICATION TO BE COMPLETE.

RELEASE STATEMENT