Paw Street Application

Application for Pet Care Assistance

Paw Street Inc.
Owner Information*

First NameLast Name
Spouse or Co-Owner

First NameLast Name
Address (If homeless, fill in City and State only) Do not leave Blank

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
(area code) + Phone Number
Email*
example@example.com
Preferred Method of Contact*

PhoneEmail
What is Your Age Group?*

18-35 Years36-59 Years60 Years and Older
Number of Adults Living In The Home*
Number of Dependent Children *
Are you employed? *
Has there recently been a major event that has caused loss of income? If Yes, please give a brief description. *
Do You Own or Rent your Home?*

RentOwnOther
Type of Housing*

ApartmentCondoSingle Family ResidencOther
Please let us know if you have plans to move from your current address*

Yes, I plan on moving within 12 months.No, I have no plans on moving.Currently facing eviction.
What is your Monthly Household Income?*
Include wages, spousal income, child support, SSDI, SSI or SS payments, pension.
Which of these government benefits do you currently recieve?*

Food StampsSection 8Utility AssistanceFree Student LunchMedicaidSSDI/SSINONE
Choose how you would like to Pay It Forward*

Volunteer at a local nonprofitHost a Fundraising Event for Paw Street.Become an active Paw Street VolunteerBecome a Paw Street Donor! Small donations grow into big donations.Not interested in Giving Back at this time.
Information About Your Pet(s)
IMPORTANT NOTICE: Paw Street Inc. cannot provide assistance for true emergency situations where funds are needed immediately.If your pet is in need of immediate, emergency care, where any delay will put the animal at risk, it is your responsibility and duty to seek care for the pet immediately! Please do NOT delay care for your pet while waiting for a response on your application.
Indicate how many dogs (# +Dogs) and cats (#+Cats) that you currently own.
Indicate how many dogs and how many cats.
How many pets are you seeking assistance for today? *
How long have your pet(s) lived with you? See example text below*
Please include pet name and type of pet. Use the letter Y for years and the letter M for months.
Is the pet up to date (UTD) on Rabies Vaccination?*

Yes, All of my pets are UTDNo, None of my pets are UTDSome but not all of my pets are UTD.
Is your pet Microchipped?

YesNoI am not sure
If your pet is microchipped, what is your pet's Microchip Number?
If you do not know your pet's microchip number, please have it scanned by a local rescue or a Paw Street Volunteer. Paw Street can assist you with registering your pet's microchip if is not already.
Has your pet been spayed or neutered?*

Yes, all of my pets are fixed.No, none of my pets are fixed.Some but not all of my pets are fixed!I do not want to fix my pet at this time.
Who is your pet's veterinarian?*
Enter N/A if you do not have an established veterinarian.
Are you able to provide adequate food for your pet on a regular basis?*
Do you have plans to rehome your pet in the near future?*

NoYesUnsure
What kind of assistance are you requesting for your pet or pets? Include pet names and type of pet that needs assistance. *
How did you hear about us?*

Friend/FamilySocial EventsSocial WorkerInternet SearchSocial MediaAnimal Rescue/ShelterVeterinarianOther
PLEASE have all required documents downloaded to your device before submitting this application. Eligibility and requirements are listed on our website at https://pawstreet.org.

Submitted applications will be recieved by Paw Street Inc. via email.
Paw Street will respond to your application request in 1 to 3 business days using the email address listed on your application.
It is your responsibility to check your email inbox daily for email messages from Paw Street and reply promptly. Delayed responses can hold up assistance for other pet owners.
Paw Street will also call for a phone interview using the number listed on your application, if you are requesting financial assistance for veterinarian care.
If we do not recieve a response,either by phone or email, after 10 days from date of application, your request for assistance will be automatically denied.
Please note that Paw Street cannot help everyone. Approval is based on available funds and other factors such as eligibiltiy, probable outcomes and prognosis.
Should be Empty:

Application for Pet Care Assistance

Information About Your Pet(s)