MAC Pet Assistance Request Form
Name
First Name
Last Name
Email
example@example.com
Address Where You Are Currently Residing:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type of address is this?
Please Select
Permanent - This is my permanent home that I rent or own.
Temporary - I'm staying with a friend or family member.
I am experiencing homelessness.
Other
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
How would you prefer to be contacted?
Please Select
Text
Email
Voicemail
Please provide proof that you currently reside in Hamilton County, TN (e.g. photo of driver's license, mail, etc.)
Please tell us what kind of assistance you are hoping to receive (please note that our funds are very limited, and we sadly cannot fulfill all requests for assistance) NOTE: funds for emergency veterinary care are not available at this time:
Please Select
Pet food
Spay/neuter
Basic vaccinations
Behavioral/training support
Emergency boarding
Assistance with rental housing pet deposit
Pet caretaking supplies
Dog house/shelter
Fence repair
Community cat support
Winter weather pet prep (straw pick up)
Other
If you are in need of emergency boarding for your pet(s), please tell us what agency(ies) you are currently partnered with for assistance (e.g. Red Cross, Family Justice Center, etc.):
Please describe your current situation, including the financial issue or hardship that has prompted this request for assistance (if applicable):
Is anyone in your household currently receiving some form of state/federal financial assistance?
Please Select
Yes
No
Application in progress
How many people live in your home? Please list the number and ages of individuals (humans only please!) in your household:
Please tell us about your pet(s) (select all that apply):
Rows
Cats
Dogs
Birds
Small Animals
Other
None
1
2
3
4
5 or more
Will you keep your pet(s) if MAC is able to provide assistance?
Yes
No
Unsure
Submit
Should be Empty: