Adam J. Anderson Scholarship Application Form

All fields marked with * are required.

Applicant Information
Parent/Guardian Information

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

School Information
Additional Questions
Fill In

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

Additional Documents to be Included with this Application Form
  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:

Applicant Authorization

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