MoHIMA

MoHIMA The Professional Accomplishment and Engagement Program

MoHIMA The Professional Accomplishment and Engagement Program

Please complete the information below so that your request may be processed.

No funds will be released unless all information is provided.

Requests for reimbursement must be within 90 days from the date of passing the exam.

Student Name
Student Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Program Director Name
Program Director Name
First
Last

Maximum file size: 268.44MB