Southern Illinois University Horse Donation Application

Donor's Name (list all owners):

Horse's Name:

Donor Business/Farm:

Mailing Address:

Email Address:

Website Address:

Phone (day):

Phone (eve):

Cell/fax/message:

Reason(s) for Donation:

Sex:

Age:

Breed/Color:

Size (hands high):

Negative Coggins Test:

Date of test:

Horse's Medical History:

Please comment on the horse's disposition:

Will this horse thrive in a pasture with up to 20 other horses?

Is the horse on pasture turn-out at present?

Current uses/Past history (eg. riding, showing, recreation, breeding):

Special needs (eg. shoeing, diet, injury, or prior compromising injury, illnesses):

* Please note that the completion of this application does NOT assure that the said horse will be accepted by the Southern Illinois University Equine Science Program. Someone from the Program will contact you regarding this application. Thank you for considering the generous gift of your horse to SIU.