Apply For Assistance

ECR Application For Assistance

Please Complete the Form Below and Submit for Review
ECR Will contact you by phone or email to discuss your request ... Thank You

Equine Community Resources
Application for Temporary Assistance
* Please fill-in all fields*

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Describe the type of assistance needed *

Please provide a description of your situation which makes this assistance necessary *

If assistance needed is due to a temporary situation can you reimburse ECR? If yes, please submit a payment plan *

Requirements for Eligibility for Assistance:
• Applicant’s horses must be personal horses; no professional or amateur horse
breeders may apply
• Applicant consents to site visit from agents of ECR.
• Documentation required for eligibility:
     *If the situation is due to loss of income from termination of employment or reduction of work hours, please provide an employer contact who can confirm this, or provide a written confirmation from the contact.
     *If the situation is due to a medical situation, please submit confirmation documentation from the physician or hospital.
     *If the situation is due to a loss of income owing to a factor not listed above, please submit relevant confirmation.
ECR may take pictures for documentation and publicity purposes.

Applicant's Signature *

Submit

ECR Application For Assistance

Equine Community ResourcesApplication for Temporary Assistance * Please fill-in all fields*

Equine Community Resources
Application for Temporary Assistance
* Please fill-in all fields*