HOPE & HEALING AT HILLENGLADE HARVEST PROGRAM QUESTIONNAIRE

This questionnaire will be used to assess your compatibility to be sponsored for our 2-month, live-in HHH Harvest Program. We are asking that you complete this Pre-Program questionnaire to the best of your ability. If you do not wish to answer a question(s), you may leave it blank… If you are accepted into the HHH Harvest Program, your answers will be used to assist The HHH Team in tailoring our Curriculum to your personal needs, as well as for your level of training to assure placement in your new Equine vocation! The more you share with us, the more we can help you – so, in-turn, you can help others upon your Certification Graduation… Please know that all information you share is 100% confidential!

Please enter a valid phone number.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Single, No KidsMarried, No KidsMarried, KidsSingle/Divorced, Kids

DenominationalNon-DenominationalOther

(FYI: HHH is a 501c3 Charitable Organization with a “FOR PROFIT” division. Our Programs are designed for those in need – EVERYONE IS WELCOME!... But please note that the HHH Team Members are all Non-Denominational, Bible-Based Christian Believers, and our faith represents our core values).

Combat VeteranNon-Combat Veteran

Service-connected, workingService-connected, not workingNo Disability ClaimN/A

* We can work with your disability status for employed or volunteer work following HHH Certification Graduation*

1 (Never) 2 (Rarely) 3 (Sometimes) 4 (Often) 5 (Always)

1 is Never, 5 is Always

HOPE & HEALING AT HILLENGLADE HARVEST PROGRAM QUESTIONNAIRE

APPLICATION INFORMATION

DEMOGRAPHICS

PERSONAL WELLNESS QUESTIONS

GENERAL QUESTIONS