Scholarship Application | Peaceful Pastures

Peaceful Pastures Scholarship Application

First name

Last name

Birthday

Month

Day

Year

Gender

Phone

Address

Areas of concern/reason for needing services.

Average monthly income

Current job

Average monthly expenses

Do you have children? If yes please list how many and their ages.

Annual income for previous tax year. (You may be asked to provide a W2 or paycheck stub to prove income amount)

Amount (if any) you feel you could contribute to each session.

Services you wish to apply for: (EA-Equine Assisted)

I certify that all information written above is accurate to the best of my knowledge, and I agree to come forth with any additional information regarding my income as it arises. I also understand that just because an application is submitted to receive these services, does not make me an automatic beneficiary of these programs.

I understand that I will be contacted within one week (upon receipt of the application) to be made aware of program availability.

I also understand that the amount of sessions given is not endless and will be agreed upon before services begin.

Signature

Signature field is empty.

Date

Month

Day

Year

Peaceful Pastures Scholarship Application

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