Bennie B. and Ernestine F. Shine Scholarship Application Form

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

• Freshman
• Sophomore
• Junior
• Senior
• Graduate Level Student

• 4.0 to 3.5
• 3.4 to 3.0
• 2.9 to 2.5

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

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

1. Letters of reference from three (3) 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 transcript of school records, including GPA, SAT or ACT scores or graduate level entrance exam scores.
    
3. A letter or some form of documented evidence of acceptance or pending acceptance to an approved health-care program. (This is not necessary for preparatory programs)

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.