SPSP Application

Which fund are you applying for? *

Full Name*

First NameLast Name

Are you a Colorado resident? (required to apply)*

YesNo

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Last 4 Digits of SSN*

DOB*

Do you:*

OwnRent

Monthly payment or rent:*

How long have you resided here?*

How many people over 18 live in your household? *

Annual Gross Household Income (please include SSI, SSDI, unemployment, child support, alimony, or any other assistance) *

Are you currently employed?*

Yes (all fields in this section are required)No (move ahead to financial section)

Employer:

Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer Phone:

Area CodePhone Number

How long have you been employed here?

Position:

Annual Salary or Hourly Rate

*You are required to use any insurance benefit before Soccer Pants Senior Paws can provide financial assistance. We also recommend that you apply for CareCredit here: https://www.carecredit.com.
Approval or denial letter will be required per our discretion.

Reason for Applying (please check all that apply)*

Do you have Care Credit? If no, apply at: https://carecredit.com*

YesNo

Do you have pet insurance?*

YesNo

If Yes - please indicate name of company, ID/member number, coverage information, and if they are able to help with veterinary costs.

Are you receiving additional financial help from any other outlets?*

YesNo

If Yes - please list here:

How much are you able to contribute towards the cost of veterinarian care for your senior pet?*

Please provide TWO of the following AND a copy of CareCredit approval amount or denial letter if you have applied.

Last Year’s Tax Return (if married filing separately, attach both tax returns)
Pay Stub (last month)
Bank Statement (last month)
SS/Disability Income (last month)
For Socs & Stripes Application - Please upload proof of Veteran status

*Applications missing documentation proving hardship won’t be processed.

Please upload files here:*

Browse Files

File Type's Accepted: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif

Senior Pet's Name:*

Pet's Age or DOB:*

DogCat

Breed:*

Please tell us about your wonderful senior pet and your connection: *

Please upload a photo of your pet:*

Browse Files

Format: JPG or PNG

What is your senior pet's diagnosis?*

What treatment is recommended (could be euthanasia)?*

Attach all veterinary records (include imaging and blood work if you have) and an estimate for treatment:*

Browse Files

File Type's Accepted: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif

I confirm that all information has been provided to the best of my knowledge. I understand that any false information given will result in the denial of my application.
In signing this application, you understand that Soccer Pants Senior Paws:

Is not responsible for the outcome of treatment or lack thereof
Is not responsible for covering all costs associated with the animal's medical treatment
Cannot assist with charges incurred prior to application approval
Does not pay for any preventative care, routine dental, spay/neuter, or vaccinations
May request back-up or additional information to support this application
May deny the request without reason; animal must be 7 years or older to qualify

Dollar amount distributed in response to this application is based on financial ability of the organization at the time of request.

Media & Marketing Disclosure:
In order to provide transparency to our donors and community, Soccer Pants Senior Paws may share photos, stories, letters, and/or updates of the pet for which you are applying for, both during and after treatment/recovery. Photos and details may be shared via social media, email marketing, or directly to our donors upon request. By submitting this application, you are consenting to allow Soccer Pants Senior Paws and their representatives to release your pet's photos and medical details to the public. I hereby waive any right to inspect or approve the finished product that may be created in connection therewith. Soccer Pants Senior Paws will NEVER share your personal information such as but not limited to: your full name, address, phone number, email address, financial status, or other personal details. I have read this release and am fully familiar with its contents.

Your name*

Date*

MonthDayYear

Signature*

Please verify that you are human*

Application Type

Applicant Information

Employment Information

Additional Information & Financials

Financial Documents

Companion Animal Information

Pet Medical Information

Signature