Bailey Scholarship Online Form — Safe Haven Equine Ministries

Bailey Scholarship Application

This application is for services provided by Safe Haven Equine Ministries for participants and their guardians who qualify for services and have financial need. We are committed to ensuring every individual access to our services. The Bailey Scholarship is provided from a private, family foundation who is committed to enriching youth development through Safe Haven.

Participant Name *

Participant Name

First Name

Last Name

Guardian/Parent Name *

Guardian/Parent Name

First Name

Last Name

Have you completed your SHEM application for services? *

Have you received the Bailey Scholarship previously? *

What would be a realistic amount for you to pay per session? *

Applies only to weekly programming, including Stable Moments. The listed amounts are PER Weekly Session.

What is your total approximate annual income for your household? *

How many dependents live in the household? *

Please explain the employment status of the parents/guardians in the household. *

Please list any financial stressors or current struggles that affect your ability to pay for services from SHEM. *

By signing this I verify that all information provided is true to the best of my knowledge. I understand that applying for this scholarship does not guarantee services or scholarship provision. *

By signing this I verify that all information provided is true to the best of my knowledge. I understand that applying for this scholarship does not guarantee services or scholarship provision.

First Name

Last Name

Sample Scholarship Assistance Scale

Household Income Percentage of Fees Covered Reduced Monthly Fee $90,000 + 25% $120

$41,000 - $89,000 50% $80

$0 - $40,000 75% $40

Bailey Scholarship Application

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