HOP 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 the completed application along with proof of residence to PO Box 2167, Hamilton, AL 35570 or email a clear, legible copy to info@hooforpaw.org. After our review, you will be contacted by HOP with additional information on how to proceed.

Applicant Full Name

First NameLast Name

Co-Applicant Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is your permanent resident located within the City Limits of Hamilton, Alabama?

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Alt Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

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

Other

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?

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 PO Box 2167, Hamilton, AL 35570 or email a clear, legible copy to info@hooforpaw.org.

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 within the city limits of Hamilton, AL. 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 Hoof or Paw'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

Co-Applicant Signature

Date