House With A Heart: Medical Grant Dog/Cat
1.) Name of Non-Profit Rescue responsible for dog/cat:
2.) NEW POLICY: Grants will be paid directly to the Rescue. Please fill in address to mail check. (Please note that the address listed below MUST match the address listed on the submitted invoice, Guidestar, or organization website.)
Zip/ Postal Code:
3.) Your Name:
6.) Is this for a Dog or a Cat?
7.) Name of Dog/Cat:
8.) Age of Dog/Cat:
9.) Breed Type:
11.) Weight of Dog/Cat in pounds:
12.) Is Dog/Cat spayed/neutered?
13.) What medical issues do you need the Grant for?
Please upload a copy of the Vet invoice:
14.) Amount needed for Medical Grant:
15.) You agree to give regular updates and pictures for this Dog/Cat.
16.) Please upload 3 images of Dog/Cat:
***Allowed file extensions are jpg, gif, png, pdf***
17.) Please describe the Dog/Cat's back story and how they came to your rescue:
18.) Additional comments:
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: House With A Heart: Medical Grant Dog/Cat
Agree & Sign