HOP Financial Assistance Application

Pet Owner Financial Assistance Application

In order to obtain spay/neuter assistance, please complete all sections of this application. Any unanswered questions may result in denial of your application. You can mail your income verification and proof benefits you indicated below that you or your household members receive to 390 County Road 2, Guin, AL 35563 or upload here or email a clear, legible copy to info@hooforpaw.org. After review, you will be contacted by a HOP representative with the status of your application. Approvals are must be accepted within 30 days of offer or they will be voided and you will need to re-apply, this is due to the variation in funds availability from month to month.
Applicant Full Name*

First NameLast Name
Co-Applicant Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Alt Phone Number
Please enter a valid phone number.
Email
example@example.com
Preferred Contact Method

PhoneEmailText
The Veterinarian requires a rabies vaccine at time of procedure IF you cannot provide an up to date rabies certificate at the time of procedure. The cost of the Rabies Vaccination is $16.00.

Total Overall Cost of Procedure with RABIES: Dogs: Spay (Females) $120.00; Neuter (Males) $115.00; Cats: Spay (Females) $115.00; Neuter (Males) $95.00

Total Overall Cost of Procedure with PROOF OF CURRENT RABIES: Dogs: Spay (Females) $104.00; Neuter (Males) $99.00; Cats: Spay (Females) $99.00; Neuter (Males) $79.00
Pet Type:*

DogCat
How did you acquire the pet(s)? (check all that apply)*

StrayFrom a rescue or shelterPurchased from a breederOther
Number of Female Dogs Needing Financial Assistance
Number of Male Dogs Needing Financial Assistance
Number of Female Cats Needing Financial Assistance
Number of Male Cats Needing Financial Assistance
How many animals, regardless of type, do you care for at your residence?*
What do you need financial assistance with? (e.g. Food, spay/neuter, vaccines, etc.)*
Use the table below to answer the next question.

Find the number of people living in your household in first column (Household Size), then move to the right to find your Household's Total Gross Annual Income. Whatever color/Tier the household size and annual household income meet in is the Tier you'll need to use to answer the question that follows the table.
Choose your Tier based on the information in the table above:*

Tier 1Tier 2Tier 3Tier 4Tier 5Tier 6
Check all boxes that apply for benefits received by any members of your household: **Must provide proof (card or letter) of benefits you've indicated you or members of your household receive. ***

social security and/or disability benefitsfood stampsMedicaidOther
How many of your household members receive these benefits that you indicated in the previous question?
Please list any additional information that would support the decision to provide you with financial assistance
File Upload - You may upload your income verification, proof of benefits you indicated in this application you or your household members receive, and any other documents that you think may be helpful here, or you can mail them to 390 County Road 2, Guin, AL 35563 or email a clear, legible copy to info@hooforpaw.org

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Eligibility Requirements:

*Person applying must be 18 years or older. Students must provide proof of enrollment status from school. *

*Applicant(s) AND pet(s) must permanently reside in Marion County, Alabama. Applications may be denied if all required items are not received. All application and financial aid approvals are subject to funds we have available at time of receipt and HOP's discretion.

Submission of this application does NOT guarantee financial assistance will be provided.

Any financial assistance that is approved will be paid directly to the veterinarian, vendor or service provider. Funds are not distributed to individuals.

Your application will not be considered without receipt of all the requested items.

Animals purchased from a breeder are NOT eligible for financial assistance unless proof of layoff or employer dismissal from job within the last 30 days can be provided.

Approval for financial assistance must be accepted within 30 days of offer or it will be voided, and you will need to re-apply, this is due to the variation in available funds from month to month.

WE DO NOT SHARE YOUR PERSONAL OR FINANCIAL INFORMATION

My signature below certifies that I/We am 18 years or older and need financial assistance for the above pet(s). The information provided is accurate and true to the best of my knowledge. I understand that the information I have provided will be used to determine the amount of assistance for which I qualify and will be kept confidential.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Co-Applicant Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Use the table below to answer the next question.