| DEMOGRAPHICS |
| First / Last Name |
|
| Graduation Year |
|
| Gender |
|
| Age |
|
Income
|
Please
consider income from all sources
|
| Year Certification Exam Taken |
|
Year Passed Exam |
|
| Number of times exam taken |
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Current level of education
|
Please
select the degree you have earned since graduation and indicate your area
of study |
| If you are currently enrolled
in a degree program, indicate the degree and area of study |
|
| Have you taken additional certification exams
for the HIM profession? |
|
| Did you pass the certification exam? |
|
| EMPLOYMENT
DATA |
| Are you employed: |
|
| Are you currently employed in the HIM profession? |
|
| If your not an HIM professional, please specify
your profession |
|
What is your title?
|
|
Are you considered management?
(if no, skip to question 18) |
|
| Number of employees you supervise |
|
|
Name of area you supervise |
|
| Please check all responsibilities
or functions of your job |
Check
all that apply
|
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