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SICSA Pet Food Assistance Application
Instructions

 

Please fill out this application completely so that we can determine if you are eligible for pet food assistance.  All information is confidential and will not be shared. SICSA can only provide pet food assistance on a temporary basis and cannot be relied upon for long-term support. You may be asked to provide proof of government assistance, unemployment, disability or other documentation of temporary hardship (reviewed on a case by case basis). 

Contact Information

First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code


Agreement

To receive assistance, you must: 

  • Be 18 years of age or older
  • Provide a picture ID
  • Provide proof of need, if requested
  • Understand that the food provided is donated and it may not be the brand you typically feed. Introducing new food to your pet may cause a temporary upset stomach. You must agree to this risk. We cannot be held liable for any medical issues as a result.  
  • Agree that the food provided is for your personal pets, and it is not for strays or feral cat colonies.
  • Agree not to breed any of your pets for profit
  • We have the right to deny your request for any reason.
  • Agree that if your pet(s) is/are not already spayed/neutered, you will work with SICSA to get your pet(s) spayed/neutered after receiving food.
  • Understand that we can provide you with food for up to 3 months.  After this period, you must show further proof of need.
Household Information

Number of persons living in your home

Number of cats in household
Yes/No for spayed or neutered cats

Number of dogs in household
Yes/No for spayed or neutered dogs

I certify that the information I have provided on this application is true and accurate.  I understand that giving any false information could result in disqualification from the program.  

Once the form is submitted, please allow 24-48 hours for pick-up confirmation. A staff member will call and/or email via the contact information provided. Please note, SICSA is open Noon-7pm Tuesday-Saturday and closed on Sunday and Monday.