Centered Riding^® Instructor Course Application

Please review the requirements to become a Centered Riding Instructor which can be found at http://www.centeredriding.org (Look under "Instructors”) Please complete this application and return it to the Clinic Organizer at least 2 weeks before the clinic. The Clinic Organizer must send a copy of each Instructor Application to the Clinic Instructors before Part I of the Course.

Course Location: __________________________ Date of Course: ____________

Applicant’s Name: _________________________________________________________________

Date of Birth: (month/day/year) ______________________ (must be 18 years old at time of course)

Street Address:_________________________________________________________________

City: (note: include postal code if it precedes city): ____________________________________

State/Prov: _________________ Zip/Postal Code: ____________ (enter only if it follows city,state or prov.)

Phone: (include country code for foreign nos.) ______________________Fax: __________________

Email: __________________________________ Cell Phone: ____________________________

____ I have ridden in at least one two- or three-day Centered Riding Open Clinic or two or more one day

Open Clinics and am attaching a copy of the Certificate of Participation from this clinic (NOTE: If

you do not have a Certificate of Participation, please provide the information below:

Date:___________ Location: ______________________Clinician: _______________________

Date:___________ Location: ______________________Clinician: _______________________

OR

I have had _________ Centered Riding^® lessons from the following Level III, Level IV Apprentice or

Level IV Clinician: (Name):________________________________________________________

(Note: In order to take the Instructor Course, one of the following is required:

Participation in a 2 day Open CR Clinic, OR 6 Centered Riding lessons and a written recommendation from a Level III Clinician, OR 4 Centered Riding lessons and a written recommendation a Level IV or Level IV Apprentice.)

___I have taught riding for at least one year

___I am able to ride with good form and control in a group at walk, trot/jog, & lope/canter (any discipline) and execute schooling figures and ride over ground poles.

Do you have any disabilities, limitations, or problems, which the clinic instructors should be aware of (injuries, taking medication, etc.)? If so, please describe:

Which disciplines do you ride, teach, and/or compete in? To what level? What is your primary discipline?

___Dressage:

___Hunt seat:

___Combined Training / Eventing:

___Western:

___Saddle seat:

___ Distance riding:

___Pleasure/recreational riding:

___Therapeutic riding:

___Other (describe):

Please answer the following questions: (use back if more room is needed)

Please describe your riding level, experience and training in horsemanship.

Please describe your experience and training in teaching riding and your education.

What are your long-term goals in horsemanship and teaching riding?

What experience have you had with Centered Riding^® and body awareness methods?

(Important!) What do you hope to learn from the Centered Riding Instructor Course?

Please return this application to the clinic organizer listed on the CR website for the clinic you wish to attend. Contact the clinic organizer with any questions you have as to costs, accommodations and procedures that will take place at the clinic.

Centered Riding^®, Inc.

P.O. Box 429, Millstone Township, NJ 08510-0429

Phone: 609-208-1100 / Fax: 609-208-1101

www.centeredriding.org / office@centeredriding.org

(Rev. August 2013)