Not in Word without a lot of work. It isn't anything you would even think
about doing to simply fill it out once. See if your scanner software has
something for this. I have a Visioneer scanner and it includes a formfiller
program.
If you are talking about using the form over and over again (more than 50
times) then maybe you want to spend the time in Word. This would be what
Word calls an "online form." Check this in help. For more about online
forms, follow the links at
http://addbalance.com/word/wordwebresources.htm#Forms or
http://word.mvps.org/FAQs/Customization/FillinTheBlanks.htm especially Dian
Chapman's series of articles. You would probably recreate the form on your
screen instead of using the scanned image, but maybe not.
Hope this helps,