Sarah’s Fund Medical Assistance Application
Helping TCH alumni stay healthy—and at home.
Applicant Information
Applicant's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / 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
-
Month
-
Day
Year
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?
Yes
No
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.
Browse Files
Drag and drop files here
Choose a file
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Financial Information
Are you able to contribute to the cost of care?
Yes
No
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)?
Yes
No
If yes, please explain:
Agreement & Signature
Signature
Submit
Should be Empty: