Bridge the Gap Pet Family Resource Referral

Bridge the Gap Pet Family Resource Referral

The Arizona Humane Society has launched the Bridge the Gap program to support pet owners in crisis. With the help of our Community Support Coordinator, we can help pet parents navigate the abundant resources in Maricopa County and help keep beloved pets in their forever homes.
Client Information
Client Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate*

MonthDayYear
Date
Were you instructed to fill out this application by an Arizona Humane Society staff member?*

YesNo
Were you referred to Arizona Humane Society for assistance by another organization?*

YesNo
Which organization referred you to the Arizona Humane Society? *

Thanks to the incredible generosity of our donors, we have a fund called the Real Time Solutions Fund available that allow us to help you and your pet. This fund is meant to help pet owners in need who are financially struggling to keep their pets due to unforeseen hardship. Filling out this application does not guarentee assistance but will allow for us to determine whether or not we are able to assist either through grants or other resources. Thank you so much for giving us this chance to assist you and your pet.
In order to apply for Financial Assistance, you must agree to the following:
- I understand that completing this form does not mean that I am approved for financial assistance and that AHS will contact me if I do qualify.
- I agree that I am the owner of the pet in which I am seeking financial assistance for.
- I agree to explain why I need financial assistance and understand that this information may be shared with our generous donors who provide grant funding.
- I understand that I will be required to upload a photo of my pet. This may also be shared with our generous donors if I am provided grant assistance.
I agree:*

Please provide a description about why you are in need of financial assistance (this is regarding your personal finances not the pet's needs)*
Please tell us what your current need is for your pet and how gaining financial assistance will allow you to keep your pet with you and ultimately prevent surrender. *
Number of Pets requesting assistance for?*

We will contact you as soon as possible during weekdays.

If you have any questions please feel free to contact Community Support Coordinator at communitysupport@azhumane.org. Please allow at least 72 business hours before following up. For immediate needs, please contact 602.997.7585 ext. 1027 within the hours of 8-5.
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Client Information