R.O.C.K., Ride On Center for Kids
PO Box 2422 Georgetown, TX 78627
2050 Rockride Lane, Georgetown, TX 78626
(512) 930-7625 office (512) 863-9231 fax
www.rockride.org
R.O.C.K. Scholarship Application Form
Hippotherapy & Therapeutic Horsemanship Only
Client fees are necessary to help defray the expense of equine assisted therapy and cover only 40% of the actual cost of each lesson.
R.O.C.K.’s Board of Directors believes that no client should be turned away due to finances. A scholarship fund is available for clients
who could not otherwise participate. Scholarship applications, as well as the Client Application must be renewed each fiscal year.
Scholarships awarded are for the full session.
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Applications for scholarships must include:
Completed Scholarship form
The first page of the most recent IRS income tax return
If the client is a minor, the tax return for the responsible party is required.
A letter to the scholarship committee explaining your need for a scholarship.
A copy of current military ID or DD-214, if applicable.
You will be notified in writing as to the scholarship amount you have been awarded.
Client Name: ____________________________________________________Date: ________________________________________
Address/City/Zip Birth date______________________________________________________________________________________
Parent/Guardian______________________________________________________________________________________________
Home phone Work phone Cell/Other _____________________________________________________________________________
Email Address________________________________________________________________________________________________
Occupation Spouse’s Occupation _________________________________________________________________________________
Responsible party _____________________________________________________________________________________________
Address/City/Zip Phone ________________________________________________________________________________________
Annual Family income________________ Number in family________Are any other family members disabled? __________________
If yes, provide details __________________________________________________________________________________________
____________________________________________________________________________________________________________
Are there unusual medical needs we should consider? _______________________________________________________________
____________________________________________________________________________________________________________
Are there any mitigating factors that should be taken into consideration? ________________________________________________
Client/parent/guardian signature: _________________________________ Date:__________________________________________
Office Use Only:
Date Approved: _____________________ Level__________________________: Date Notified: ______________________________
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Client Application v4