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MoHIMA Reimbursement for Credentialing Exam Entrance Fee Application

Student Information

Please complete the information below so that your request may be processed.

No funds will be released unless all information is provided.

Requests for reimbursement must be within 90 days from the date of passing the exam.

1. Student Information
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
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2. Exam Results *This question is required.