Paws 4 A Cure - Applying For Assistance

DO NOT COMPLETE THE ONLINE APPLICATION UNTIL YOU HAVE ALL OF YOUR REQUIRED DOCUMENTATION GATHERED AND READY TO BE EMAILED.

If your required documentation is not received within 48 hours of the your online application, your application will move from pending status to closed status and you will have to reapply for assistance.

Please do not fill out the below if you are not going to follow through with the application process. Every application needs our attention, by you not submitting in your documentation, it takes us away from those that do.

* Required Fields

** If you do not check the boxes below, your application cannot be processed. Incomplete applications will be automatically denied. **

* I have read and agree to Paws 4 A Cure's guidelines, policies and procedures.

* I understand that Paws 4 A Cure CANNOT assist with charges incurred prior to approval of application.

* I understand that Paws 4 A Cure CANNOT pay for diagnostics (testing).

* I understand that Paws 4 A Cure does not pay for spaying/neutering, vaccinations or euthanasia.

* I understand that the maximum grant amount if approved for assistance is $500.

* I have added grants@paws4acure.org into my email address book as a safe contact.

* I have all of my documentation ready to be emailed or faxed. If not, STOP HERE.

* I understand that I should not rely on a grant from Paws 4 A Cure only. I have or will apply to several different financial assistance programs along with applying to Paws 4 A Cure, links to which can be found on the Helpful Resources page.

* I understand that my online application will not be responded to until all of my required documentation is received by Paws 4 A Cure.

Please turn OFF your CAPS LOCK before filling out the application for assistance below.

YOUR INFORMATION

* Your First and Last Name

* Date of Birth

* Street Address

* City

* State

* Zip Code

* Email Address

* Confirm Your Email Address: *REQUIRED

* Contact Phone #

* Your Employer Name

* Your MONTHLY net income

* Marital Status:

Spouse/Domestic Partner's First and Last Name

Spouse/Domestic Partner's Date of Birth

Spouse/Domestic Partner's Employer

Spouse/Domestic Partner's total MONTHLY net income

* Living Situation

* How many adults (over 18 years of age) are in your home?

* How many children (under 18 years of age) are in your home?

* NAME, RELATIONSHIP and BIRTH DATE of EVERYONE living in the home. Examples: John Smith (roommate) 07/17/1967 or Jane Smith (daughter) 05/23/2011. Do not include yourself.

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* Is your total household income normally above poverty level?

Yes
No

* Do you own or rent your home

* Monthly Rent/Mortgage

* Please select the statement that applies to your normal financial situation

Other please explain

Please check all that apply to your current financial situation:

I receive child support
I receive alimony
I receive a monthly inheritance
I receive unemployment benefits
I receive disability payments
I receive Social Security
I receive public assistance (welfare, food stamps, etc.)

Unemployment benefits amount received monthly

Child support amount received monthly

Alimony amount received monthly

Disability benefit amount received monthly

Social Security benefit amount received monthly

Public assistance received monthly

* Please explain why you cannot afford the veterinary care. (Not about your dog/cat's veterinary care, you will answer about your dog/cat's needs later.)

How did you hear about Paws 4 A Cure?

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* About The Dog/Cat

Dog
Cat

* Dog/Cat's Name

Dog Breed

* Age

* Sex

Male
Female

* Spayed/Neutered

* Please explain your pet's illness or injury.

* Diagnosis (must have a diagnosis from veterinary office)

* Please explain the treatment received so far and the initial onset of the illness or injury.

* Please explain the treatment still needed. (As a reminder: Paws 4 A Cure CANNOT assist with charges incurred prior to approval of application and receipt by the veterinarian of the Acceptance Letter.)

* I have applied for CareCredit?

Yes
No

* Were you approved for CareCredit?

Yes
No

Amount approved from Care Credit

* What is the estimated cost of the proposed treatment? (Your veterinary practice must provide an estimate for services still needed.)

* What amount are you able to contribute towards your pet's veterinary care?

* What amount are you asking for Paws 4 A Cure's help? (maximum grant is $500)

* Is the dog/cat receiving financial assistance from any other organization?

Yes
No

Please list the organization and amount received. A list of organizations can be found on our Helpful Resources page.

Please provide the link to your GoFundMe page

Please provide the link to your YouCaring page

Please provide any other fundraising URL that you have

* Explain in detail how have you been trying to raise money for your dog/cat's veterinary care.

Pet Insurance Company Name

Policy #

Contact #

VETERINARIAN INFORMATION

You must have a treating veterinary practice.

* Treating Veterinarian's Name

* Veterinary Practice's Name

* Veterinary Practice's Address

* City

* State

* Zip Code

* Phone Number

Fax Number

Veterinary Practice's Email Address

Please be advised that your application will be immediately denied if you did not click on the 8 check boxes at the top of the application, if you do not complete the required fields with a * next to them or the drop down menus are not used. Please scroll up to review your application for financial assistance to ensure that ALL required fields have been completed.

* I have reviewed my application for financial assistance and have completed all of the required fields including the drop down menus.

* I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for a grant.

* Type your full name below that you certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for a grant.

Applying For Assistance

Application For Financial Assistance