Sarah's Fund Application

Sarah’s Fund Medical Assistance Application

Helping TCH alumni stay healthy—and at home.
Applicant Information
Applicant's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: 000-000-0000.
Email
example@example.com
Cat Information
Cat's Name
Approximate Age
Date of Adoption from The Cat House

MonthDayYear
Date
Cat's Current Diet
Please list: Dry/Wet Food Brand/Type, Amount, Frequency
Medical Concern
Please describe the medical issue or concern - explain symptoms, timeline, any diagnoses.
Is your cat currently under veterinary care for this issue?
If yes, what clinic is providing care?
Has your cat received any treatment for this issue already? Describe treatments received, if any.
Upload any veterinary records or cost estimates.

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Financial Information
Are you able to contribute to the cost of care?
If yes, approximately how much?
Are you receiving any public assistance?
Examples: food stamps, housing assistance, etc.
Have you applied for or received assistance from other sources (e.g., CareCredit, other nonprofits)?
If yes, please explain:
Agreement & Signature
Signature
Should be Empty:

Sarah’s Fund Medical Assistance Application