TSMSS Scholarship App.

Applying for:

TSMSS Conference

Cindy Gassiot Reimbursement Award

NAMSS Professional Development Course at TSMSS Conference

Name

Phone

1. How long have you been a member of TMSS?

2. Are you a current member of NAMMS?

Yes

3. Are you a current member of a TMSS Chapter?

Yes

If yes, what is the name of the chapter?

4. Indicate reason for applying for TSMSS Scholarship:

Budget constraint

Other

* Include a brief statement below as to why you are applying for the scholarship.

* Eligibility requirements are listed below:

A) You must be a current active member of TSMSS and currently employed in a position with the primary responsibility of healthcare credentialing (i.e., hospital, managed care, government agency). Provide details of your current position, primary responsibilities, and paste your resume below (plain text please).

B) Write a short essay evidencing your commitment toward the profession (i.e., indicate educational goals, professional memberships, extracurricular activities, future employment goals) and how you might be able to volunteer for a TSMSS activity.

C) List two (2) peer references (i.e., supervisor, CEO, physician) include name, address, telephone number for contact:

Peer One:

Hospital:

Position:

Mailing Address

City/State/Zip

Phone

Peer Two:

Hospital:

Position:

Mailing Address

City/State/Zip

Phone

*Required
YOU MUST ENTER YOUR EMAIL TO CONTINUE

*Email address

Once you submit you will be re-directed TSMSS Website. Thank you!

* Indicates Response Required