How To Apply

Instructions for Applying for Assistance

Financial Assistance is provided ONLY for the following types of care:

1. Urgent Care (diagnostic testing, broken leg, etc.)
2. Emergency Care (life-threatening injuries or illnesses)

You, the pet owner, must meet eligibility criteria:

1. Low-income household; or
2. Elderly pet owner; or
3. Disabled pet owner; or
4. Veteran pet owner

Before You Start

You will need to have the following items available to help you complete the financial portion of the application. We advise that you gather this information together before you begin your application.

1. Proof of Income — This can be a copy of a check stub, unemployment benefits, disability benefits, etc. The proof of income must be recent, and we cannot use tax forms for this purpose.
2. A copy of a written cost estimate for the needed procedures and/or treatment from your veterinarian.
3. The name, address, and medical license number for your treating veterinarian.

Please note — no contributions are EVER given directly to individuals. Helping Hands ONLY sends funding directly to the treating veterinarians once your application is approved and treatment is provided. Funding resources are limited, and Helping Hands makes every effort to use limited funds in the most responsible way.

** Helping Hands Animal Assistance does not discriminate on the basis of age, sex, or race. Helping Hands reserves the right to deny funding to anyone for any reason. Please read the complete application agreement for details of the application process. **

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Application

Please fill out all fields and enter 'N/A' or 'not applicable' for non-applicable items.

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Your Information

First Name

Last Name

Phone

Email

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Current Address

Street

City

State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

Zip Code

Have you been at your current address for less than 3 years?

Yes

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Previous Address

Street

City

State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

Zip Code

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Employer Information

Employer Name

Employer Phone

Employer City

Employer State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

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Household Information

Household Income

Household Residents 1 2 3 4 5 6 7 8 9 10+

Household Animals 1 2 3 4 5 6+

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Animal Information

Type Dog Cat Other

Other Animal Type

Age Less than 1 year old 1 year old 2 years old 3 years old 4 years old 5 years old 6 years old 7 years old 8 years old 9 years old 10+ years old

Are they up to date on their vaccines?

Yes

No

Medical Issue

Previous Medical Issues

Veterinarian Providing Care

Current Veterinarian (if different)

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Why do you think you should be approved?

Sending...

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