Positive Tails Grant Application

Before You Apply:

1. Our funding is limited to residents of New York City at this time.

2. If you are experiencing an emergency, please seek help right away at the nearest veterinary hospital.

3. Positive Tails is unable to fund treatment for ongoing and chronic conditions.

Contact Info

Please enter information about the animal's guardian

Name*

Organization

Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Cell Phone*

Email

example@example.com

Pet's Name*

Species:*

example: cat or dog

Breed:

example: labrador mix

Color*

Age or Date of Birth*

Gender:*

MaleFemaleDon't know

Is the animal spayed or neutered?*

YesNoDon't know

Date of last heat or litter:

Are there any other unfixed animals in the household?*

YesNoOther

How long have you had this pet?*

Where did you acquire this pet?*

Current on vaccines?*

YesNoDon't knowOther

Have they had a heartworm test?*

YesNoDon't knowOther

Are they currently taking heartworm prevention medication?*

YesNoDon't knowOther

Any allergies?*

YesNoDon't knowOther

Do you have other pets?*

YesNoOther

Name of regular veterinarian or any other veterinarian who has treated your pet?

Issues of concern/reason for applying for assistance*

Where did you hear about Positive Tails?

Please provide ONE of the following as proof of financial need:

Copy of last year’s tax return, W-2 form, 3 months of paystubs, EBT card, Proof of Unemployment, Social Security, Worker’s Compensation or Disability income or VA benefits letter.

*Bank statements are not acceptable as proof of financial need.

Email documents to grants@positivetails.org

Spay and neuter surgeries are expensive. Positive Tails is 100% donor funded. Your donation will go towards the shared mission of providing veterinary care for all. Visit positivetails.org/donate to complete your contribution.

Amount of your contribution:*

I attest that the information I have provided to Positive Tails is accurate and complete. I give my consent for the above mentioned medical care. I understand that Positive Tails assumes no liability and makes no assurances as to the appropriateness, quality or outcome of any medical diagnosis, treatment, products or services. I consent to allow Positive Tails the use of any pictures and description of medical care for the purposes of promotion and fundraising. Grants are subject to the discretion of the Board of Directors, funds available and procedures outlined in the application guidelines.

Grant Application: Spay/Neuter

Contact Info

Patient Information