Apply For Help

Handicapped Pets Foundation Grant Application

The mission of the Handicapped Pets Foundation is to support caretakers of elderly, disabled, and special needs pets with the equipment, especially dog wheelchairs, they need to live happy, healthy lives. Assistance is provided for those people with a demonstrated financial need.

Please note that you will have 30 minutes to complete the application form before the session will time out and you will have to re-submit the information

The Handicapped Pets Foundation cannot accommodate all of the requests that are received. We only respond to requests that are approved after being reviewed. If you are approved for a mobility equipment grant, you will be notified within 10 days of your application being submitted.

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Applicant First Name(*)
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Applicant Last Name(*)
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Mailing Address (*)
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City(*)
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State
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Zip Code
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Day Phone
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Alternate Phone
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E-mail Address(*)
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Rescue Group
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Your affiliation with group
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Have you ever received a Handicapped Pets Foundation Grant? *
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If so, when?

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How did you hear about us?
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If other, please specify
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About the Animal

Animal Name
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Species
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If other
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Breed
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Age
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Weight
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Sex
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Spayed/Neutered?
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If not, what are your plans to have this done?
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When did you acquire the animal ?

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Circumstances
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Describe the circumstances of where this animal came from, and how s/he became the responsibility of the applicant.

Plans for animal
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About the Animal's Injury or Illness and Treatment

Does this case involve animal cruelty charges?
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If so, please indicate the police department and report number:

Police Department
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Report Number
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Describe the animal's health
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Describe the animal's injury or illness. Include a description of the injury or illness, how long the animal has been sick or injured and the cause of the injury or illness.

Equipment and/or treatment
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Indicate the specific equipment and/or treatment needed, the urgency of the treatment and any follow-up care required.

What is the estimated total cost of treatment and equipment?
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How much are you able to personally contribute?
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How much have you received from other donations?
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Donations you have received
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List any donations you have received for the treatment of this animal. Include the name of the contributing organization(s) and the amount of their donation(s).

About the Clinic Treating the Animal

Clinic Name
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Clinic Address
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Clinic City
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Clinic State
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Clinic Zip Code
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Clinic Phone
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Clinic Fax
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I am mailing Proof of financial Hardship
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Proof of financial Hardship
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Applications who attach proof here will be given consideration first.
In order to make sure that our assistance goes to the families who need it the most, we ask that you show us that you are already receiving support from state or local government assistance programs. Proof of financial hardship involves a document in your name that shows you are getting state aid or assistance. These include disability, welfare, food stamps, section 8 housing assistance, TANF, and more. Please upload a scan or photograph the document or mail a copy to our address (copies will not be returned).

Applications will only be processed when you click "Submit". No applications will be processed via mail or fax.

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