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Seniors with Pets Assistance Program Application
SPA Grant
This grant is for those 65 and older who don't have the funds to hire pet sitters/dog walkers or pay extra veterinary bills, and have no family and friends who can assist.
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Email Newsletter Opt In
*
I would like to receive your monthly e-newsletter.
Yes
No
Phone
*
Best time of day to be reached.
*
Permanent Mailing Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
What assistance do you need for your pet at this time? This could include, but not be limited to: medical assistance, help with dog walking, pet food delivery, litter box cleaning, or trips to the vet.
*
Pet Name, Age, Species, and Estimated Weight
*
Is Your Pet Spayed or Neutered?
*
No
Yes
Pet Sex
*
Male
Female
Please describe what medical procedure you would like NiSHA to assist with.
*
Pet Photo/Story Waiver
*
I agree to let NiSHA use my pet’s story/photo in grant reporting and in social media or other NiSHA publications.
Yes
No
