Horsemanship Student Scholarship Application

Horsemanship Student Scholarship Application

Please review the Horsemanship Student Scholarship Policy prior to submitting this form. Complete all required sections and acknowledgement statements carefully.
Student Information
Name of Student

First NameLast Name
Is the Student currently enrolled in Horsemanship Lessons?
Scholarship Level Requested
Primary Adult / Responsible Party

If Student is a minor or has a legal guardian
Name

First NameLast Name
Relationship to Student
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Other Responsible Party (Optional)
Name

First NameMiddle NameLast Name
Relationship
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Household Information
Student resides with
Size of family/household
What other benefits does the household receive? (Disability, SNAP, unemployment, etc)
What other activities & therapies does the student participate in, and how often?
Essay / Narrative Questions
How do you believe Therapeutic Horsemanship will or has benefited the student?
Describe any unusual circumstances, such as debt or illness, that contribute to the need for a scholarship.
Additional information to take into consideration
Agreement and Acknowledgement
Confirmation and Acknowledgement
Signature (typed name indicates signature)

First NameLast Name
Date

MonthDayYear
Date
Should be Empty: