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SECTION I: DEMOGRAPHIC INFORMATION

Applicant demographic information.

Note: This application form will not allow you to save answers and revisit; it must be completed in one sitting. To help prepare your answers for online submission, you may download a PDF of the application here.

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* 1. Demographic information of person completing application.

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* 2. Type of organization (select all that apply).

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* 3. Size of Organization

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* 4. Organizational Staffing - Employees

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* 5. Organizational Staffing - HIM Professionals

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* 6. Organizational Staffing - AHIMA Credentialed HIM Professionals

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* 7. Please list all job titles and credentials for the HIM professionals who are employed within your organization.

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