CHIA Research Support Awards Application

Research Support Awards Application
For more information about eligibility and full requirement details, visit http://www.californiahia.org/research-support-awards

Applicants may submit an application at any time throughout the year.
Name*

First NameLast Name
Credentials
AHIMA/CHIA ID Number*
CHIA Membership Status*

Student MemberGraduate MemberActive Member
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Email*
Name of College/University*
Name of Master’s or Doctoral Degree Program (in health information, health informatics, or related discipline)*
Expected Program Graduation Date*

MonthDayYear
Narrative Responses

Provide a brief response (50-200 words) to the following questions.
A brief description of the research project, including a clear research plan and a clear statement of the relevance of the project to the HIM profession*
An estimate of the direct cost associated with the research project* *
*e.g. For qualitative research: costs to transcribe interviews, postage, local travel; for quantitative research: purchase of data sets; expenses excluded include computer equipment, unreasonable travel, other unreasonable expenses.
A brief description of the expected outcomes of the project and the anticipated submission date*
Required Documentation & Acknowledgments
Curriculum Vitae (PDF only)*

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Transcripts (PDF only)*

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I acknowledge that I will provide an article reporting on the results of the research project to be published in the CHIA Journal*

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Signature
I acknowledge that I am willing to present the research findings at a CHIA-sponsored webinar or other educational forum*

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Signature
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Research Support Awards Application

Narrative Responses

Required Documentation & Acknowledgments