Name:

First

Last

Address:

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

E-mail:

Phone:

Area Code

Phone Number

Applying for:

Open

Jr/YR

State how you intend to use the award:

Educational activities attended in the last five years related to dressage education. See PDF for examples.

Highest level of schooling:

Highest level of competition:

List any awards/recognition/certification

Describe your volunteer activities/contributions to CTDA, the USDF, and Region 3 within the last 3 years:

Reference 1:

Reference's email:

Reference 1 phone:

Area Code

Phone Number

Reference 2:

Reference 2 email:

Reference 2 phone:

Area Code

Phone Number

Please select the box to certify that you understand that if awarded the scholarship you will be expected to write an article on your experience for the CTDA newsletter and that you understand that to receive the scholarship funds you must submit the following to the CTDA: proof of expenses or payment of fees and verification of completion of activity or study.

I understand and agree to the terms.