Herdina Grant 2024

The Albert and Anna Herdina Memorial Fund for Animals
Please fill out the following fields to the best of your ability and as accurately as possible.
Applicant's Information
Client Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Number of people in household*
Monthly Income*
Source of income*
Number of Cats on Property*
Number of Dogs on Property*
Number of Other Animals on Property (Small Domestics, Farm, Livestock)*
Type "None" if Not Applicable
Pet in Need of Care
Name of pet in need of veterinary care*
Breed*
Sex of Animal*

MaleFemale
Age*
Is your animal sterilized/fixed?*
Please upload a picture of your Pet

If you have difficulty uploading, Please email to samantha@afv.org.
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Information of Veterinarian Care Requested
We highly encourage you to get in contact with a veterinarian office prior to applying for a grant to expedite the process. However if you are not in contact with a vet at this time, AFV will offer you a vet office to contact for further action. Please be aware this may lengthen the time before you pet recieves care.
Name of Veterinarian Office*
Type "None" if you do not have a current vet
Phone Number of Veterinarian's Office
Brief description of care needed*
To expedite grant approval, please upload the following required documents.

Applications cannot be approved until all required items are verified.
1. Proof of age (66 years of age or older, Driver's License or Identification Card)

2. One document providing income level (i.e. recent bank account statement, current years SSI Benefit Letter) Eligibility: Maximum Gross Income of $1700 a month per person

3. Proof of residency (utility bill, rent reciept, etc.). *Must be permanent in Southwest Riverside County.*

You may also email the files seperately to samanta@afv.org.

You can also turn in your documents in person to Animal Friends of the Valleys @ 33751 Mission Trail, Wildomar, CA 92595 during open hours.
File Upload

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The information provided above is accurate. I understand that the Herdina Fund is limited an I may not receive assistance, even if I qualify, if there is no more funding available for the current year.

Please understand that our programs cannot cover full vet bills. We provide assistance to help as many low income and/or senior residents within our jurisdiction. It is also up to the veterinarian to honor our grants as some may choose not to accept them.

Payments will be made directly to the veterinary office, not the individual.
Client Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

The Albert and Anna Herdina Memorial Fund for Animals

Applicant's Information

Pet in Need of Care

Information of Veterinarian Care Requested

To expedite grant approval, please upload the following required documents.