Healthcare CIO Boot Camp Military Member Scholarship Program

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Healthcare CIO Boot Camp Military Member Scholarship Program

Application Form

I. Applicant Information (ALL fields required)
Candidate’s name:
Job Title:
Organization:
Address:
City:
State:	Zip:
Phone:	Fax:
Email:
Membership Status (please check one): I am a current member of CHIME I am applying for the following session (please select one): Fall 2012 Spring 2013 Fall 2013 The following items must be included with your application form: Current resume Scholarship essay Letter of recommendation

You will be required to submit the above documents on the next page.

Questions or comments? Send an email to staff@cio-chime.org.

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Upcoming Events
	February 20, 2012 CHIME/HIMSS Spring CIO Forum Las Vegas, Nevada
	April 14-17, 2012 Healthcare CIO Boot Camp Gleacher Center at University of Chicago, Chicago, Illinois
	October 13-16, 2012 CHIME Healthcare CIO Boot Camp Renaissance Esmeralda Indian Wells, California
	October 16-19, 2012 CHIME12 Fall CIO Forum Renaissance Esmeralda Indian Wells, California

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