TUITION WAIVER APPLICATION

Horse Heritage Educational Program
TUITION WAIVER APPLICATION
Rider’s name
Date of Birth

MonthDayYear
Date
Disability
Amount Requesting
Part I

Demographics (information requested applies to Parent/Guardian or Independent Student)
Parent / Guardian Name
Spouse’s Name
Home Phone:
Work Phone:
Cell Phone:
Student resides with:

MotherFatherBoth ParentsGuardianSelf
Address:
Are you:

MarriedSingleDivorced/SeparatedWidowed
Number of Children:
Ages:
No. living at home
Part II

Financial Resources
Total Monthly Income

Indicate how much money you receive each month from each of these sources

**You need to submit proof of income including: W-2, or Tax Return annually, DSHS statements, etc**

Cancelof
Part III

Narrative
In what other activities and therapy does the student participate and how often?
How have you volunteer or contributed in support of HHEP?
How does therapeutic riding benefit you (if independent student) or your child? What do you or he/she find most enjoyable about therapeutic riding?
4. Please list any unusual circumstances (debt, illness, etc) that contributes to your need for assistance
Any additional comments
Part IV
- Did you remember to:
- Submit your most current proof on income (W-2 or tax return)?
- Complete and update any contact information?
- Complete your income information?
- Sign and date the application?
I certify that the information provided in this application is complete and correct to the
Signature*

Clear
Date

MonthDayYear
Date
Printed Name
Applications must be submitted to Horse Heritage two weeks prior to the start of the session. Late or INCOMPLETE applications will NOT be considered.
Should be Empty:

Part I