Scholarship Template


HIMSS Midwest Gateway Chapter Scholarship Application

The scholarship applicant must be a HIMSS student member ($30) in good standing and select Midwest Gateway Chapter membership (free).

The scholarship applicant must be a full-time student in an accredited undergraduate or graduate program related to the healthcare information or management systems field.


All fields are required

  • Student information
  • First Name
  • Last Name
  • Email
  • Phone Number
  • Student’s Mailing Address
  • HIMSS Member ID
  • Major/Program Currently Enrolled In
  • University Name
  • University Mailing Address
  • Your Current GPA


Professional involvement

Write N/A if it does not apply

  1. Professional or academic societies or associations to which you belong and any leadership roles and/or achievements.
  2. Personal achievements or extracurricular involvement in organizations outside of professional/academic organizations.
  3. Involvement you have had with HIMSS (attended HIMSS Global Health Conference, participated as a program assistant, volunteered with your local chapter, etc.)
  4. Conferences, seminars, or symposiums you have attended that were related to healthcare information and management systems.


Interest in health information and technology

  1. In your own words (500-1,500), describe how you believe the use of information and technology in healthcare can improve the quality of care delivered in the United States / Canada and around the world.
  2. In your own words (500-1,500), describe how you believe the HIMSS Chapter Scholarship funds can assist you in gaining an educational experience that will promote the use of health information and technology in the future.





By submitting your application, you attest to the information being submitted as your original work. Email your completed application and resume to