1. First Name of Donor *

2. Last Name of Donor *

3. Mailing address *

4. City *

5. State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

6. Zip Code

7. Email

8. Phone number *

Cell Extension

9. Mount Holyoke Alumna: Yes No

10. Horse Information

Breed *

Sex * Female Male

Height *

Age *

11. Training Background/Accomplishments *

12. Vices (i.e. cribbling, weaving) *

13. Attitude on the ground/in the stall *

14. Medical Background (including routine maintenance) *

15. Diet (including supplements) *

16. Reason for Donating *

17. Can your horse Jump? * Yes No

18. Is he/she a Dressage prospect? * Yes No

19. Can your horse Lesson in Groups? * Yes No

20. Does the horse require turnout? * Yes No

21. If Yes, normal turnout time: