Adam J. Anderson Scholarship Application Form

For applicants that are still in high school, please fill out the information below pertaining to your parent/guardian.

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

Provide a narrative explaining each of the following items listed below:

1. Letters of reference from two (2) persons (not relatives, parents, or personal friends).  Suggestions would be a teacher, minister, employer or counselor.  List names of references & include letters in your application packet.
    
2. A letter or some form of documented evidence of acceptance or pending acceptance to an approved health-care program.

Please attach the following items below:

Please read the following statement carefully and add your signature in the space provided.

I hereby authorize investigation of all statements contained in this application. I affirm that all information contained in this document is true and complete and that any misrepresentation, falsification or willful omission herein shall be sufficient reason for refusal of scholarship.

Questions? Please contact Spencer Hospital's Human Resources Development Department at (712) 264-6117 or by email at sph_grp.hrd@spencerhospital.org.