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* 1. Name

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* 2. Company (if applicable)

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* 3. Address

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* 4. Which exam are you applying for this scholarship?

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* 5. Education Level (list highest level completed)

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* 6. Work Experience in Medical Billing (enter years)

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* 7. Please describe steps you have already taken to advance your medical or specifically radiology coding career. 

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* 8. If you are awarded the scholarship and pass the exam, how do you plan to use your radiology coding certification (RCC or RCCIR)?

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* 9. Would it be a financial hardship to apply and take the RCCB exam?  If yes, please explain.

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* 10. What are your career goals regarding radiology coding and how would the RCC or RCCIR credential benefit you and your career?

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* 11. Describe in detail a recent accomplishment that was not career oriented.

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* 12. Please obtain a recommendation Letter from a creditable authority, such as a professor or employer, and upload it here.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 13. Background check document from https://exclusions.oig.hhs.gov/SearchResults.aspx.  Please click on this website address, search for your name, print and save the results as a PDF and include with application.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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