Hope Animal Rescue · Community Assistance Program

We provide financial assistance and resources to pet parents struggling with economic hardship. Decisions are based upon several factors, including medical urgency, financial need, available funding, and eligibility. Due to the overwhelming number of applications we receive, we cannot help everyone.

Once an application has been submitted, you can expect to receive a response by email or phone within one to three business days. Please be sure to check your email for confirmation that your application was submitted, as well as for a response to your application.

We are not equipped to respond to emergency situations and urge you to take your pet to the nearest urgent care veterinarian if you find your pet is in a life or death situation requiring immediate medical attention.

Contact Information

Name

*

First Name

Last Name

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

*

Email

*

Verify Email

*

How did you hear about Hope Animal Rescue?

*

Type of Assistance Requested

Please Note: We DO NOT offer emergency care assistance. If your pet is suffering from a life-threatening injury or illness, please take them to the nearest urgent care veterinarian immediately.

Descriptions of Care

Basic care (spay and neuter procedures, dental, vaccinations, etc.)

Non-basic, non-urgent care (cancer treatment, heart disease, etc.)

Urgent care (diagnostic testing, broken leg, etc.)

Pet supplies (food, crates, leashes, collars, monthly preventatives, etc.)

Choose From the Following

*

Basic Care

Non-Basic, Non-Urgent Care

Urgent Care

Pet Supplies

Pet Information

Pet's Name

*

Is the pet spayed or neutered?

*

No

Yes

Is the pet up to date on their rabies vaccine?

*

No

Yes

If No, Please Explain

Pet's Age

*

Pet's Species

*

Pet's Breed

*

Pet's Sex

*

Female

Male

Is your pet pregnant and/or in heat?

*

No

Yes

Unsure

How did you acquire this pet?

*

How long have you had this pet?

*

Please tell us why you are seeking assistance for your pet

*

Veterinarian's Name

Clinic Name

Clinic Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Clinic Phone

Clinic Email

Verify Email

Demographic Information

Number of Adults in the Household

*

Number of Children in the Household

*

Number of Pets in the Household

*

Access to Resources

Please Check if You Are

A full-time student

Home-bound

Does a member of the household participate in any of the following programs?

Food Stamps

Medicaid

Section 8 Benefits

Social Security Disability (SSDI)

Social Security Supplemental (SSI)

Unemployment Benefits

WIC

Monthly Household Income

*

Assistance is not based solely on income. Include all sources.

Under $500

$500 - $749

$750 - $999

$1000 - $1499

$1500+

Income Source(s)

*

Employment

Disability

Government Assistance

Retirement Income/Social Security

None

Other

Have you applied for Care Credit?

*

No

Yes

Can you drive your pet to a veterinarian for care?

*

No

Yes

Acknowledgement and Consent

*

I understand that missed veterinary appointments may result in discharge from assistance through Hope Animal Rescue.

*

I understand that Hope Animal Rescue takes no financial or legal responsibility for the wellbeing or care of my pet.

*

I understand that no payments will be made to any one person, only to veterinary clinics and suppliers.

*

I certify that the information provided is accurate to the best of my knowledge.