• ERCT Scholarship Application

  • Thank you for your interest in our Scholarship Program. We understand that every family's journey is unique, and we appreciate you taking the time to share yours with us.

    The purpose of this application is to help us better understand your family's financial need, your child's goals, and how participation in our program could make a meaningful impact. We are not asking for medical diagnoses or detailed personal history. Instead, we invite you to share the information you feel is most relevant about your child's strengths, challenges, and the support they may benefit from while participating at Hearts.

    All information provided will be kept confidential and used solely to help us make thoughtful scholarship decisions and ensure we can best support your family.

    Thank you for allowing us the opportunity to learn more about your child. We are honored to be considered as part of their journey.

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Preferred Method of Contact

  • Rider Information

  • Has the rider previously participated at Hearts?

  • Financial Needs

  • How many family members are in your household?

  • Child's Needs & Goals

  • What goals do you have for your child through participation in our program?

  • Impact of the Scholarship

  • Commitment & Participation

  • If awarded a scholarship, are you able to commit to regular attendance? We only provide rides during the week day, NOT weekends.
  • Is a parent/guardian willing to participate in program communication and progress updates?

  • Final Section

  • Should be Empty: