Full Name (optional)  (optional)

Age :

Responsible Party

(If Under Age):

Facility:

Total Cost Of Service:

Percent Requested:

Length Of Service

Would you, or is there someone you know, assist Manes & Tails with their Fundraising Committee or other events:

If yes please list name/names

Pictures or videos are sometimes taken during classes to aid training or for demonstration. Do you give your consent for public release of pictures or video.

Date:
Manes & Tails
Text Box: Manes & Tails is a non-profit organization. A scholarship fund is available to individuals and families wishing to participate in equine activities and who could not otherwise do so. Funds are limited but each applicant will be considered and every effort will be make to assist with costs. Please contact your intended facility for a no charge visit prior to completing and submitting this application. Please complete the following form, click the print button bellow, be sure to sign the form and mail to: Manes and Tails, c/o Pamela S Scheppele, 27 Westwind Drive, Caribou, ME 04736 If you have any questions or problems with this application you can contact Brian at bnouellette@msn.com or 207-227-0853 .

Scholarship Application
Text Box:

Brief Summary Of Need

Address:

Phone:

E-mail:

Signature:____________________________

November 17, 2007

Gender :