Share-the-Ride Scholarship Application

Applicant Information

Client's Name(Required)

First Last

Age(Required)

Primary Diagnosis(Required)

Please select which one(s) applies to you/the client.(Required)

Financial Aid

Foster Child Program

Parent/Guardian/Caregiver’s Information

Name(Required)

First Last

Phone(Required)

Relationship to Client(Required)

Annual Household Income(Required)

Source of Income (Job, SSI, etc)(Required)

Total Number of Individuals in Client’s Primary Household(Required)

Total Number of Dependents in Client’s Primary Household(Required)

Is Client Considered a Dependent?(Required)

Yes

No

Please Explain Why the Client Needs a Scholarship(Required)

Have You Received Scholarship Funding From PALS Before?(Required)

Yes

No

If yes, when?(Required)

Please email the first two pages of the last fiscal year’s 1040 tax return, or other proof of income to lee@palsindiana.org.

Please note, your application is not complete until you send this information in. All information is kept confidential within the PALS administration.

Name(Required)

First Last

Relationship to Client(Required)

Phone(Required)

Email(Required)

Date(Required)

Signature(Required)

Share-the-Ride Scholarships Policies

PALS and individual donors provide funding for a number of scholarships that are available to clients who are in need of financial assistance for therapeutic equine assisted activities. Please note that scholarship awards are reevaluated each session and are not guaranteed. Scholarships are awarded on a first-come first-serve basis.

Requirements of Scholarship Recipient:

– Scholarship recipients are responsible for paying the monthly balance on or before the due date indicated on the invoice. Payment arrangements can be made, but must be done in advance of the due date.
– Failure to pay by due date or to make payment arrangements may result in ineligibility to apply for a scholarship for the following month.
– For an unexcused absence, recipients are responsible for paying the full lesson fees.

Scholarship Support May be Revoked if:

– A participant’s billing account is overdue and not in good standing.
– A participant receiving funding has two “no call/no show” absences at scheduled lesson times.

A participant whose scholarship funds are removed is responsible for paying the full balance of any remaining lessons at the current rate per lesson.

Signature(Required)

Date(Required)

Applicant Information

Parent/Guardian/Caregiver’s Information

Please email the first two pages of the last fiscal year’s 1040 tax return, or other proof of income to lee@palsindiana.org.

Share-the-Ride Scholarships Policies

Requirements of Scholarship Recipient:

Scholarship Support May be Revoked if:

A participant whose scholarship funds are removed is responsible for paying the full balance of any remaining lessons at the current rate per lesson.

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