Pet Cremation Application

Pet Cremation Application

This form should be used if you are requesting assistance for Pet Cremation.
While we do not require submission of these documents at the time of your application, please note we may request them in order to process your application.

If a request for documentation is made, you must provide it within 24 hours.
- I have items needed to show proof of financial need:
  - Tax returns
  - Social Security Award Letter
  - Retirement Statement showing monthly Income
  - 30 days worth of pay statements
- I have items needed to show proof of residency:
  - Two utility statements in my name or
  - A copy of my lease agreement
- I have give ALL Veterinary Clinics / Pet Crematories involved with the after life care of my pet permission to speak with a representative from Hobo's Healing Heart.
Application Status
Sympathy Card Send
Denial Reason
My pet has already passed away.
If no, Hobo's Healing Heart will call my vet and my veterinarian will confirm saying goodbye is medically necessary and in the best interest of my pet.
I understand Hobo's Healing Heart is a South Dakota Nonprofit serving specific counties located within the Black Hills. What County do you reside in?
I understand I may need to produce the above mentioned documents if requested within 24 hours.
I understand all requests for documentation will be made via email and I should be checking my email regularly to ensure I respond within 24 hours.
Enter TODAY's Date

MonthDayYear

Prequalification Form
I understand Hobo's Healing Heart does not pay for the cost of Euthanasia.
I understand Hobo's Healing Heart will only cover of the cost of cremation and a basic urn if funding is available and I may be required to pay a portion of the cost.
I agree to have my pet's photo, story, and my testimony shared so donor can see how their funds are helping families and pets in need.
I understand IF approved, Hobo's Healing Heart pays grant funds directly to the veterinary clinic / crematory and NOT the pet owner.
Have you applied for a grant with Hobo's Healing Heart in the past?
If yes, enter date of last application

MonthDayYear
Enter the amount of assistance you received.
I have paid all prior veterinary bills associated with a past grants in full.

Required Documents
Please provide your favorite photo of your pet. If your grant is approved and you agreed, this photo will be used pay tribute to your pet and share with supporters and donors via email, on our website, or any of our social media outlets to show the impact of their contributions. (Optional - however very appreciated)

Cancelof

Applicant Information
Owner Name

First NameLast Name
Address

Physical Street Address

Mailing Address if different than Physical Address

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
We will not contact your employer regarding your cremation assistance application. This information is collected solely for use when seeking sponsors for our annual fundraiser.

Your privacy is important to us. We will never share that you applied for a grant, and if you are approved, we will never share that you received assistance from Hobo’s Healing Heart.

If you choose to share your experience, we truly appreciate it, as it helps raise awareness of our mission—but sharing is always completely optional.
Name of Employer (optional)
If retired or on disability please indicate so here.
Name of Supervisor (optional)

First Name Enter NA if noneLast Name Enter NA if none
Address of Employer (optional)

Street Address Enter NA if none

Street Address Line 2

City Enter NA if noneState / Province Enter NA if none

Postal / Zip Code Enter NA if none
Email of Employer (optional)
example@example.com Enter NA@NA.com if none
Phone number of Employer (optional)
Please enter a valid phone number. Enter 123-456-7890 if noneFormat: (000) 000-0000.
Total number of working adults in household
Total number of people living in household
Projected household gross income this year?
Gross income is the amount you make before taxes are taken out. Household income includes all working adults.
Gross household income last year?
Gross income is the amount you make before taxes are taken out. Household income includes all working adults.
Gross household income two years ago?
Gross income is the amount you make before taxes are taken out. Household income includes all working adults.
How did you hear about us?
If you receive a grant, what will it mean to you and your family? (Optional - however very appreciated and will be used as a testimony for donors to see their impact).

Pet Information
Pet's Name
Pet Species
Pet's Weight
Age of Pet

Licensed Veterinary Care Provider or Pet Crematory Information
I have a veterinary clinic or pet crematory I am working with.
Name of Veterinary Clinic or Pet Crematory
Name of Contact Person

First NameLast Name
Address of Veterinary Clinic or Pet Crematory

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Veterinary Clinic or Pet Crematory
example@example.com
Phone Number of Veterinary Clinic or Pet Crematory
Please enter a valid phone number.Format: (000) 000-0000.
What is the estimated cost of cremation with a basic provided to you by your Licensed Veterinary Clinic or Pet Crematory?

Demographic Information and Application Submission

The following questions are OPTIONAL and may help us when applying for grants. None of the information provided in this section will be used to determine your grant eligibility.
Date of Birth

MonthDayYear
Sex
Race
Ethnicity
Please verify that you are human
Should be Empty:

Pet Cremation Application

Prequalification Form

Required Documents

Applicant Information

Pet Information

Licensed Veterinary Care Provider or Pet Crematory Information

Demographic Information and Application Submission