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WYHIMA Exam Fee Reimbursement Application

Please complete the Exam Fee Reimbursement Application and submit with the requested documents.

If you have any questions please refer to the WYHIMA Exam Fee Reimbursement Program document on the WYHIMA webpage or send an inquiry to
Personal Information
This question requires a valid email address.
Education Information
Required Documentation

Scan and upload the following documentation.
Written documentations showing your exam date and that the exam was successfully passed. (AHIMA Score Report) *This question is required.
Signature *This question is required.
Signature of
Note: application must be received by WYHIMA within six (6) months after passing exam.
This question requires a valid date format of MM/DD/YYYY.