PAWS 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 upload or mail income verification and proof benefits you indicated below that you or your household members receive to PO Box 534, Vernon, AL 35592 or email a clear, legible copy to info@lchspaws‐al.org. After review, you will be contacted by a PAWS representative with additional information.

**Due to individuals taking advantage of our program and using friend's or family's Lamar County addresses for approval, you will be required to submit proof of residency for your application to be approved. If it is determined that you are not a Lamar County, AL resident after you've been approved and your pet's procedure has already been completed we reserve the right to deny the charges at the vet's office and have them billed in full without our discount to the person's name on the application provided.**

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

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*

$92

Number of Male Dogs Needing Financial Assistance*

$87

Number of Female Cats Needing Financial Assistance*

$82

Number of Male Cats Needing Financial Assistance*

$45

Do these animals have an up-to-date rabies vaccination?*

Are any of these animals microchipped?*

**If you CAN provide proof of an up to date rabies vaccination certificate (within the last 12 months from the date of the appointment) the cost of the rabies vaccination will be deducted from your amount due. We CANNOT deduct the amount due without proof of vaccination in hand first.**

How many animals, regardless of type, do you care for at your residence?*

How many of these animals were rescues or adoptions?*

** USE THE BELOW TABLE TO ANSWER THE NEXT QUESTION, INPUT THE TIER NUMBER THAT ALIGNS WITH YOUR HOUSEHOLD INCOME. FIND THE NUMBER OF PEOPLE IN YOUR HOUSEHOLD THEN MOVE TO THE RIGHT AND FIND THE TIER THAT YOUR GROSS ANNUAL HOUSEHOLD INCOME FALLS INTO. EXAMPLE: HOUSEHOLD GROSS ANNUAL INCOME IS $45,000 AND YOU HAVE 2 PEOPLE IN YOUR HOUSEHOLD, YOU WOULD ANSWER THE NEXT QUESTION WITH TIER 2.**

Using the above table, what is your household's total gross (before taxes) annual income?*

We appreciate your application and truly thank you for working to be a responsible pet owner. You do not qualify for additional financial assistance but can still get our price, all we require is that the full balance be paid at least three (3) business days before your appointment or it will be automatically cancelled. To continue, please complete your animal's information using this link https://form.jotform.com/240978897860176

Does anyone in your household receive social security/disability benefits, food stamps, or enrolled in medicaid? **must provide proof of benefits (card or letter) if you choose yes***

Please list any additional information that would support the decision to provide you with financial assistance

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 PO Box 534, Vernon, AL 35592 or email to info@lchspaws-al.org

Acceptable items for proof of residency are below, they must be dated within the last 90 days and match the address provided in the application.

Utility Bills: Electric, water, gas, and internet bills.
Bank Statements: Showing your address. - black out any account informaiton
Lease Agreements: If you're renting.
Mortgage Statements: If you own your home.
Pay Stubs: Showing your address.
Driver's Licenses: Or other government-issued IDs.
Insurance Documents: Like car insurance or health insurance.
Vehicle Registration
Tax Returns: (State or federal).
School Transcripts: If you are a student.
Homestead Documentation
Letters from Organizations: If you are living in a shelter or with a nonprofit.
Employment Documents: Like work IDs.
Social Security Statements
Government Checks
Court Documents

Upload proof of residency or email it to info@lchspaws-al.org

Acceptable items for proof of residency listed above.

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 Lamar 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 LCHS|PAWS'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*

Date*

Date

Co-Applicant Signature

Date