Naples Therapeutic Riding Center
206 Ridge Drive, Naples, Florida 34108
Phone: (239) 596-2988 / Fax: (239) 514-2908
Email: program@ntrc.org   Web: www.NaplesTherapeuticRidingCenter.org

Financial Assistance Annual Request Form
Application                                                                                       Date:	 Participant Name:        	 Phone Number:	 	 

Status (Check One)

•	Currently riding with NTRC	_
•	New Participant
•	

Request for

Program (Check One)
•	One eight-week session	 	 o   Date of Session	 	
•	Annual scholarship	 	
•	Other (please describe)	_

Amount (Check One)
•	Partial scholarship (50%)	 	
•	Full scholarship
•	Other (please describe)	_
•	

Naples Therapeutic Riding Center (NTRC) provides financial assistance based upon:
•	Financial need of family (this information will be kept confidential)
•	Funds available for scholarship

One of Naples Therapeutic Riding Center's goals is to provide therapeutic riding to all individuals appropriate to participate in the program, without regard to ability to pay. Wherever possible, Naples Therapeutic Riding Center tries to help meet rider needs.

Scholarship renewal and approval is annual.

Applicant's (or Parent/Guardian's) Signature	Date

Naples Therapeutic Riding Center
206 Ridge Drive, Naples, Florida 34108
Phone: (239) 596-2988 I Fax: (239) 514-2908
Email:   program@ntrc.org  Web: www.NaplesTherapeuticRidingCenter.org

Financial Assistance Annual Request

In order to establish financial need we accept any of one the following documentation from applicants:
If applicant is under the age of 21:
•	Letter from school verifying student is on the Free/Reduced lunch program; or
•	Medicaid (Coverage for Children) card;
•	Florida Healthy Kids Eligibility Confirmation
•	Parent or Guardian receiving SSI;
•	Previous year's tax return showing income at or below 200% of 2021 Federal Poverty Level.
If applicant is over the age of 21:
•	SSI;
•	Medicaid Card *(in participants name);
•	Previous year's tax return showing income at or below 200% of 2021 Federal Poverty Level
*Medicaid will not be billed for NTRC services.

Return the financial assistance request from to NTRC. The form will be reviewed, and you will be notified if you qualify for assistance. Be sure to clarify if you are requesting full or partial assistance.

Participant Commitment
By applying for NTRC financial assistance you understand there is an agreement on your part to attend weekly riding lessons. If you are unable to attend your scheduled riding lesson, you are required to contact the NTRC office to make them aware of your absence.

In 8-week period participants on scholarship will be permitted I absence regardless if it is an excused or unexcused absence. In case of emergency or unexpected urgent situations, please contact the NTRC office to discuss further.

Thank you for making this commitment to riding and for understanding the importance of contacting NTRC if you are unable to participate.

Please List Forms Included:    	

Applicant's (or Parent/Guardian's) Signature	Date

Naples Therapeutic Riding Center
206 Ridge Drive, Naples, Florida 34108
Phone: (239) 596-2988 I Fax: (239) 514-2908
Email:  program@ntrc.org Web: www.NaplesTherapeuticRidinRCenter.org

To be completed by NTRC Program Director

Scholarship Committee Comments:
For NTRC internal use only: Documentation provided & date of eligibility

Approved by:

& ------------

(Scholarship Committee Member)	(Second Scholarship Committee Member)

Program Director Signature: --------------------­ Executive Director Signature:   	

Date Letter sent to Participant: ----------