Auxiliary Scholarship Application Form

Applicant Name
Today's Date
Address
Course Information
Qualifications & Requirements

Qualifications: Spencer area residents enrolled in second, third, or fourth year nursing or healthcare related accredited program. OR, enrollment in a short-term program or course to expand knowledge or upgrade current job skills for a Spencer Hospital employee.

Requirements: To be considered, please submit the following by the announced deadline: Completed application form, proof of enrollment into the program/school where funds would be directed, personal letter briefly discussing current school or work status, community or volunteer activities and career goals along with three letters of reference.

Education


Work Experience



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. In addition, I grant Spencer Municipal Hospital Auxiliary permission to contact any previous employers listed on this application except those indicated.

Questions? Please contact Beth Henningsen at (712) 264-8451 or by email at bhenningsen@spencerhospital.org.