Mentoring Inquiry Form
First Name
Last Name
Phone number
Email
Address
City
State
Zip Code
Do you currently volunteer, work or participate with an existing Equine-Assisted Services program:
Yes
No
If yes, where is your center located? If a future program desired, where do you want that program to be located:
At what level do you participate with the existing or future program? (check all that apply):
Instructor
PT/OT/SLP/Mental Health Therapist
Administration
Funding/Development/Funding Staff
Volunteer Managment
Board of Directors
Other Programming Staff (Horse Management Etc.)
What services does your program currently offer? (check all that apply):
Adaptive Riding
Therapy Services (Including PT, OT, SLP OR Mental Health)
Carriage Driving
Equine-Assisted Learning (Including Ground Activities)
Veterans
Vaulting
Have not begun programming yet
What would you like to learn more about? Please rate the following topics on a scale of 1-3, (1) being most important to learn about, (3) being least important.
#1
Please select...
General getting started
Executive Director consultation
Financial managment
Administration
Policy/Procedure
Donor relations
Volunteer management
Horse managment
Fundraising
Marketing
Grant writing
Adaptive riding or instructor consultation
Therapy or participant consultation
Facility management
Board management
PATH Intl. accreditation
#2
Please select...
General getting started
Executive Director consultation
Financial managment
Administration
Policy/Procedure
Donor relations
Volunteer management
Horse managment
Fundraising
Marketing
Grant writing
Adaptive riding or instructor consultation
Therapy or participant consultation
Facility management
Board management
PATH Intl. accreditation
#3
Please select...
General getting started
Executive Director consultation
Financial managment
Administration
Policy/Procedure
Donor relations
Volunteer management
Horse managment
Fundraising
Marketing
Grant writing
Adaptive riding or instructor consultation
Therapy or participant consultation
Facility management
Board management
PATH Intl. accreditation
After your free consultation, we will provide more information about additional services. We have a variety of packages starting at just $100 with the ability for customization. There are a limited number of scholarships available for our services. Do you anticipate a need for scholarship?
Yes, I want more information about a scholarship.
Not at this time.
Thank you for taking the time to complete this form. This information will help us identify who can help you best. You will receive an email after clicking submit with further instructions on scheduling your first free session!
Contact Information