HWAH- Rescue Partner Qualification Form


General Info

Name of Rescue

Name of Contact person

Phone

Address (Please note that the address listed below MUST match the address listed on the submitted invoice, Guidestar, or organization website.)

 

Email

Website

Date of 501(c)(3)

 

EIN #

History Info

Do you do Home Visits before Placement?

Will you take a dog/cat back if the adopter wants to give it up?

You agree to give regular updates and pictures for the dogs/cats that we help.

Please attach a copy of your adoption contract:

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB

Rescue Vet Reference

Rescue Vet's Phone number

Rescue Groomer Reference

Rescue Groomer's Phone number

Previous Adopter References

Please list 2 References below:

1st Adopter Reference Name

 

Adopted Dog/Cat Info

Name Breed

Age

1st Adopter Reference phone #

City/State

 

Email

 

2nd Adopter Reference Name

 

Adopted Dog/Cat Info

Name Breed

Age

2nd Adopter Reference phone #

City/State

 

Email

Leave this empty:

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Signature Certificate
Document name: HWAH- Rescue Partner Qualification Form
lock iconUnique Document ID: a5588a01099c1f4479662c0b0d844ce1c7dd7779
Timestamp Audit
June 28, 2021 9:12 am EDTHWAH- Rescue Partner Qualification Form Uploaded by Fiscal Sponsorship - fsp@unitedcharitable.org IP 72.73.25.226
September 20, 2021 2:10 pm EDTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 108.28.172.231
September 20, 2021 2:10 pm EDTSher Polvinale - hwahsher@gmail.com added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 108.28.172.231
February 22, 2023 4:53 pm EDTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
February 22, 2023 4:53 pm EDTSher Polvinale - hwahsher@gmail.com added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
February 23, 2023 9:13 am EDTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
February 23, 2023 9:13 am EDTSher Polvinale - hwahsher@gmail.com added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
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