UTAH HORSE COUNCIL, INC.
5615 N 6300 W
Mt. Green, UT 84050
SCHOLARSHIP REQUEST
( ) date
NAME & ADDRESS OF ORGANIZATION:
CONTACT TEL. NUMBER:
CONTACT PERSON:
FEDERAL TAX IDENTIFICATION NUMBER:
OR TAX EXEMPT STATUS
AMOUNT REQUESTED $ ______________
DESCRIPTION OF REQUEST:
(Detailed description of the purpose and how the funds will be used to promote your charitable functions)
(Please attach a second page if necessary)
SIGNATURE OF ORGANIZATION’S REPRESENTATIVE: ______________________________
UTAH HORSE COUNCIL, INC. use only
Date of Board Approval _______________________________
Board Signature _______________________________
Date of Payment _______________________________
Check Number _______________________________
Applications will be reviewed in:
May & December
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