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Fort Madison Community Hospital Auxiliary Scholarship Application

Complete Application must be received prior to April 1st.  

A complete application includes the six documents below. 

  1. Application Form
  2. Letter stating why I believe I should be a recipient
  3. Letter of support from a personal contact (non-relation)
  4. Letter of support from a professional contact
  5. EFC from FASFA
  6. High school transcript for the past 7 semesters (If applicable)

The above documents should be received at the following address by April 1st:

Fort Madison Community Hospital
Attn: Auxiliary President
5445 Avenue O, P.O. Box 174
Fort Madison, IA 52627

If you would like to submit via email- 

To print a paper copy of this scholarship click here.

Required fields are marked with a

Personal Information
First Name:
Middle Name:
Last Name:
Email Address:
Street Address
Zip Code
High School Attended
Year of High School Graduation
College, University or Technical Institute that you plan to attend:
Year & Term you plan to attend:
Area of Study
Before submitting your application, carefully read the statement below.
By submitting this application, you agree to the following: I hereby affirm that the information provided on this application is true and complete. I understand that any false or misleading representations or omissions made on the application or scholarship interview process may disqualify me from further consideration for this scholarship.
I understand that this application is not complete until FMCH has recieved my high school transcript, letter stating why I believe I should recieve this scholarship, a personal reference letter, a professional reference letter and a copy of the FAFSA- EFC form. ONE FILE CAN BE UPLOADED, please scan/combine files to make one document to upload or mail your additional documents to the hospital.
By Checking this box I am electronically signing this application, I hereby apply for an Auxiliary Scholarship awarded at an awards ceremony in May. If I am awarded a scholarship, I authorize the Fort Madison Community Hospital to use my name in any press release or publication related to the Fort Madison Community Hospital Auxiliary Scholarship Award.
I accept
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