Mentoring Inquiry Form

First Name

Last Name

Phone number

Email

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you currently volunteer, work or participate with an existing Equine-Assisted Services program:

If yes, where is your center located? If a future program desired, where do you want that program to be located:

At what level do you participate with the existing or future program? (check all that apply):

What services does your program currently offer? (check all that apply):

What would you like to learn more about? Please rate the following topics on a scale of 1-3, (1) being most important to learn about, (3) being least important.

#1

#2

#3

After your free consultation, we will provide more information about additional services. We have a variety of packages starting at just $100 with the ability for customization. There are a limited number of scholarships available for our services. Do you anticipate a need for scholarship?

Thank you for taking the time to complete this form. This information will help us identify who can help you best. You will receive an email after clicking submit with further instructions on scheduling your first free session!