APPLICATION FOR THE VINIAR-CONWAY SCHOLARSHIP FUND FOR THERAPEUTIC RIDING & HORSE-ASSISSTED ACTIVITIES

The Scholarship Committee will review your application and supporting documents anonymously. All information will be kept confidential. In the application, there is a space to explain how COVID-19 or other situations may have affected your income and/or expenses. Applications must be submitted with the following supporting documents:

Most recent tax return (1040 and W-2) copy
Two most recent pay stubs or unemployment stubs
Current lease agreement or mortgage statement and property tax bill
Copy of utility bills from previous month (phone, gas and electric)
Child support documentation
Documentation that you/your family receive government assistance such as TANF, WIC, SSI, disability, housing assistance, etc.

You may email scans of the above documents to Leigh@ponypowernj.org or mail hard copies to Pony Power Therapies, 1170 Ramapo Valley Rd., Mahwah, NJ 07430. Applications without supporting documents will not be considered.

The Scholarship Committee will review your application and supporting documents anonymously. All information will be kept confidential. Pony Power cannot fund all applications. Submitting an application does not guarantee that you will receive a scholarship.

Pony Power believes a strong sense of ownership and pride is developed if the recipient contributes to the cost of their involvement. Please review the fee schedule below and state a specific dollar amount in the application field asking how much of the fee you would be comfortable paying.

You must complete BOTH a registration form and the scholarship application. One will not be considered without the other.

Applicant Information

Applicant (Parent/Guardian) First Name

Applicant (Parent/Guardian) Last Name

Relationship to Participant

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

I am interested in requesting scholarship for the following program(s):

Therapeutic Riding ($510 for 6 weeks in winter & summer/ $1020 for 12 weeks in spring and fall)Horse-assisted Learning (non-riding, grooming & horsemanship focus) (($390 for 6 weeks in winter & summer/ $780 for 12 weeks in spring and fall)All HANDs In Program, Tuesdays (new participants must interview) ($330 for 6 weeks summer & winter and $660 for 12 weeks spring & fall)Gardening-assisted Learning ($240 for six weeks)Forest Babies ($300 for six weeks)Children's Half-Day Summer Program ($630 per individual)Teen Half-Day Summer Program ($630 per individual)Adult Half-Day Summer Program ($500 per individual)

Household Information

How many family members do you have noted as dependents for tax purposes?

Dependent 1

Dependent 1 - First Name

Dependent 1 - Last Name

Dependent 1 - Date of Birth

Dependent 1 - Relationship to Applicant

Dependent 2

Dependent 2 - First Name

Dependent 2 - Last Name

Dependent 2 - Date of Birth

Dependent 2 - Relationship to Applicant

Dependent 3

Dependent 3 - First Name

Dependent 3 - Last Name

Dependent 3 - Date of Birth

Dependent 3 - Relationship to Applicant

Dependent 4

Dependent 4 - First Name

Dependent 4 - Last Name

Dependent 4 - Date of Birth

Dependent 4 - Relationship to Applicant

How many adults live in the household?

How many children live in the household?

Additional Comments

Do you own a home/condominium?

YesNo

Home/Condominium

What is the address?

Address Line 1

Address Line 2

City

State

Zip Code

What is the monthly mortgage payment?

Do you rent?

YesNo

How much rent do you pay each month?

Policies and Signature

By submitting a scholarship application, you are authorizing Pony Power Therapies to verify all of the information provided. You may be asked to supply documentation or information beyond what is required for submission with your application. Regular fees will be in effect until you are notified that you are a scholarship recipient. Pony Power reserves the right to refuse assistance to any applicant.

PONY POWER THERAPIES POLICIES

PAYMENT

SELF-PAY (with financial aid): The agreed upon payment is due by the start of lessons. You may pay by check or online:

https://ponypowertherapies.formstack.com/forms/balance_payment

ABSENCES

Program dates are posted on the calendar at the bottom of our home page: ponypowernj.org.
Scholarship recipients who miss more than 2 lessons will be dismissed from the scholarship program; payments made toward the semester of activities will be nonrefundable.
Lessons will be held rain or shine.
Please call, text or email Pony Power to notify us of an absence.

SEVERE WEATHER

Pony Power will determine the need for canceling lessons due to bad weather or extreme temperatures. In the event of a last-minute decision to cancel, we will make every effort to reach you by text, email and/or phone call at least one hour prior to the scheduled lesson. If you are unsure of the weather conditions and have not heard from Pony Power prior to leaving for your lesson, please call: 201-934-1001. Pony Power Therapies will not allow participants to ride in the event of thunder and lightning. If a storm occurs during programming, participants scheduled to ride will then work with their instructor on our horsemanship curriculum in the main aisle of the barn.

Pony Power Therapies reserves the right to suspend riding and/or horse-assisted learning activities if sessions are deemed unsafe/inappropriate for any reason.

REQUIRED APPAREL

All participants must wear long pants and closed-toe shoes (sneakers or boots) and dress for outdoor temperatures. Riders must wear a boot with a low heel, long pants and have their own ASTMI-certified riding helmet. Helmets are available locally at Ramapo Saddlery in Mahwah, 201-512-1418.

Is there anything else we should know about you and your family? Please note if COVID-19 or other situations have affected your income and/or expenses recently.

How much of the fee would you be comfortable paying? Please state a dollar amount (refer to the pricing listed above). Your application will not be considered without a dollar amount.

By signing this form, I guarantee the above information is true to the best of my knowledge, and I allow Pony Power Therapies to check the above information. I also understand my application will not be considered without the required supporting documents.

I do

Initials

Date