Please complete the application below

Family Name of Applicant*

First NameLast Name

Dog/Cat Name*

THE COMPASSION FUND IS ALLOCATED WHEN FUNDS ARE AVAILABLE

These funds can NOT be used for:

Examinations
Heartworm testing, Ear Cytologies, Fecal Flotations
Prevention (flea/tick, dewormer, heartworm)
Third Party fees (cremation, Radiologist review, etc)
Microchipping
Vaccinations
Sterlization (spay/neuter)
Boarding

These funds CAN be used for:

Advanced Diagnostics (ex: ultrasound, radiographs, echocardiogram)
Advanced surgeries, including orthopedic

In order to get approved for the Compassion Fund, you must have an estimate from CHEW. If you have not been seen, please call CHEW and schedule an appointment UPLOAD ESTIMATE HERE:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Are you at least 18 years old? This does not disqualify your application*

YesNo

Is this your first time applying for the CHEW Compassion Fund?*

YesNo

How many people over the age of 18 live in your home?*

How many people under the age of 18 live in your home?*

Marital Status*

Are you currently employed?*

Are any adults (other than you) in your home currently employed?*

What is your combined yearly income?

How long have you been unemployed?

We understand that financial challenges can arise from various situations, including changes in employment. To help us assess your eligibility for assistance and provide the most appropriate support, we kindly ask if you're willing to share your current employment status and, if applicable, the reason for unemployment. Additionally, if you're comfortable, please let us know whether you are actively seeking employment or planning to do so in the near future. Please note that providing this information is voluntary and will be kept strictly confidential (comment "no comment" if you do not wish to share this information*

Provide the name of the pet who needs a one-time assistance? *

Have you tried to raise money to help cover this procedure? (gofundme, fundly.com, waggle.org, etc)*

YesNo

Please provide the links to your fundraising campaigns

CHEW's Compassion Fund is unable to cover 100%, what amount are you able to contribute? *

IN ORDER TO QUALIFY FOR THE COMPASSION FUND, YOU MUST FIRST APPLY FOR CARECREDIT AND SCRATCHPAY

CHEW Animal Clinic is pleased to offer convenient financing options through CareCredit and Scratchpay!

NOTE: CareCredit/ScratchPay are soft credit checks with no impact to your credit score.

Please note that completing these CareCredit/ScratchPay is required before your Compassion Fund request can be considered. Getting approved for these financing options doesn’t obligate you to use them in full, nor does it disqualify you from receiving assistance from the Compassion Fund.

The application process only takes about 5 minutes, apply online by clicking below.

HIGHLIGHTS OF CARECREDIT: CLICK HERE
Extended Payment Plans
Interest Free For 6 Months*
Quick & Easy Approval
Immediate Access to Funds
No Annual Fee

HIGHLIGHTS OF SCRATCHPAY: CLICK HERE
Instant Approval
Plans as low as 0% APR
No hidden fees
No prepayment penalty
No deferred interest

CARECREDIT RESULTS*

SCRATCHPAY RESULTS*

List any other ways you are trying to raise funds to cover this procedure?

THE FOLLOWING IS REQUIRED, AND IF NOT UPLOADED, YOUR APPLICATION WILL BE DECLINED

THE FOLLOWING MUST BE UPLOADED: W-2 withholding statements. This document must have your name and YTD earnings

THE FOLLOWING MUST BE UPLOADED: ONE month Paycheck stubs. This document must have your name and current balance

THE FOLLOWING MUST BE UPLOADED: ONE month bank statement. This document must have your name and current balance

THE FOLLOWING MUST BE UPLOADED: Current Social Security Disability or other Disability Income

THE FOLLOWING MUST BE UPLOADED: Unemployment Benefits

THE FOLLOWING MUST BE UPLOADED: Current Welfare Recipient

THE FOLLOWING MUST BE UPLOADED: Current Medicaid Card:

Other circumstances that indicate financial hardship can be uploaded here, such as: (a) Proof of bankruptcy settlement (b) Catastrophic situations (death or disability in family, divorce (c) Or other documentation that prove financial hardship.

Provide proof of identity with at least one of the following
Current Driver’s License
Passport
State-Issued Identification Card

Upload proof of identity here:*

I have read and agree to the terms & conditions. I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge.

The Compassion Fund is reviewed by a dedicated volunteer committee. While sharing your story and a photo of you and your pet may not directly impact your chances of receiving assistance, it does help make your situation more personal. Would you like to upload a picture and share your story for the committee to review? This may also be used on social media platforms to help with fundraising efforts.*

Your Story*

Your Picture*

While leaving a review on Yelp or Google isn’t required, it can make a big difference in helping us continue our successful fundraising efforts. Many donors look at these reviews before deciding to contribute, so your feedback can play a crucial role in supporting our mission. Would you be willing to leave us a review?*