Veteran Funding Application

Veteran Funding Application

Please complete this form in its entirety.
Veteran's Name*

First NameLast Name
Email*
example@example.com
Service Animal's Name*
Branch of Service*

Air ForceArmyCoast GuardMarine CorpsNavy
Were you honorably discharged and able to provide supportive documentation?*
Requested Funding Amount*
Veterinary Clinic Name*
Veterinary Clinic City*
Veterinary Clinic State*
Veteran and Service Animal Documentation*

Please upload documentation proving veteran and discharge status as well as proof of registered service animal.
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Applicant Certification Statement

I certify that the information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that providing false or misleading information may result in denial of assistance or repayment obligations. I authorize the LivTiv Foundation to verify any information provided, including contacting my listed veterinary provider for confirmation of estimates or services.
Signature*

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Applicant Certification Statement