2021 EFP Scholarship Application

Equuvation's Equine-facilitated Psychotherapy Scholarship Application

DEADLINE TO APPLY: Must be received by May 26, 2021
May is Mental Health Awareness Month – and while we do our best to celebrate mental health awareness every day – it is the perfect opportunity for us to launch this news... we are offering TWO fully-paid scholarships for new clients to receive a 12-session Equine-facilitated Psychotherapy (EFP) package during our Summer Semester (June 7 through August 29)!

There will be NO COST to the awarded participants, however he/she must meet our criteria in full in order to be considered. A brief phone interview with our Clinical Director will be required following submission of eligible applications.

Scholarships are not guaranteed. The number of scholarships we can award each semester is directly tied to our scholarship fund, supported by private donors.

**THIS APPLICATION IS CONFIDENTIAL AND INFORMATION SUBMITTED WILL NOT BE SHARED WITH ANYONE OUTSIDE OF THE CLINICAL DEPARTMENT WITHIN OUR ORGANIZATION. ALL MEMBERS OF EQUUVATION HAVE SIGNED CONFIDENTIALITY AGREEMENTS.**

Value of each EFP package is $1800.

If you have questions, contact erica@equuvation.org.
Name*

First NameLast Name
Date of Birth (must be 18 or over)*

DayMonthYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Phone Number*

Area CodePhone Number
Please select the day(s) and timeframe(s) you would be available for sessions [please check all that may apply - we will coordinate with you on final schedule]:*

Mondays – MORNING {between 9am and noon}Mondays – AFTERNOON {between 1pm and 4pm}Mondays – EVENING {between 4pm and 6pm}Wednesdays – MORNING {between 9am and noon}Wednesdays – AFTERNOON {between 1pm and 4pm}Wednesdays – EVENING {between 4pm and 6pm}Other
Please share WHY you are applying for this scholarship opportunity:*
What GOALS might you have for yourself if you were to be awarded this scholarship opportunity:*
Have you participated in Equine-facilitated Psychotherapy (EFP/EAP) before?*

YesNo
If yes, and you are comfortable sharing, please list the program(s) you participated in below:
Do you have previous experience with horses?*

Yes – a lot!Yes – some.NoneOther
If you have previous experience with horses, please explain:
Have you participated in other therapeutic services? If yes, please describe:
Annual Household Income

Less than $25,000$25,000-$50,000$50,000-$100,000$100,000-$250,000$250,000 or moreOther
How many incomes contribute to your household?

OneTwoThreeOther
I affirm that the information in this application, on behalf of the participant listed, is true and accurate according to my knowledge.
Today's Date*

DayMonthYear
TYPE NAME / Signature*
Other comments/questions:
There will be NO COST to the awarded participants, however he/she must meet our criteria in full in order to be considered. A brief phone interview with our Clinical Director will be required following submission of eligible applications.

Scholarships are not guaranteed. The number of scholarships we can award each semester is directly tied to our scholarship fund, supported by private donors.

**THIS APPLICATION IS CONFIDENTIAL AND INFORMATION SUBMITTED WILL NOT BE SHARED WITH ANYONE OUTSIDE OF THE CLINICAL DEPARTMENT WITHIN OUR ORGANIZATION. ALL MEMBERS OF EQUUVATION HAVE SIGNED CONFIDENTIALITY AGREEMENTS.**

Value of each EFP package is $1800.

If you have questions, contact erica@equuvation.org.
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Equuvation's Equine-facilitated Psychotherapy Scholarship Application