Personal information
Name
*
First Name
Last Name
Email
*
example@example.com
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.
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Pets Information
Pets Name
*
Sex
*
Male
Female
Spayed/ Neuter
*
Yes
No
Unknown
Dog Breed
*
Pets color
*
Estimated date of birth
*
-
Month
-
Day
Year
Date
Pets need/ Concern
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Proof Of Need
To qualify for free or low-cost services through Hope 4 Hounds, applicants must provide proof of income to verify eligibility. This ensures that assistance is directed to individuals and families who need it most.
Accepted forms of proof of income include:
Recent pay stubs (within the last 30 days) Government assistance documentation (SNAP, SSI, SSDI, unemployment, etc.) Tax return (most recent year) Employer verification letter Bank statements showing income deposits Applicants may also provide proof of participation in income-based programs, which may automatically qualify them for services.
All information submitted will remain confidential and used solely to determine eligibility for Hope 4 Hounds programs.
Number of People in Household
*
Income Verification (Self-Reported). I certify that my household income falls within the low-income guidelines as required to receive services. Estimated Total Monthly Household Income
*
Source(s) of Income (check all that apply):
*
Employment
Unemployment Benefits
Government Assistance
Disability
Social Security
Child Support/Alimony
No Income
Other
Proof of income
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I certify that the information provided above is true and accurate to the best of my knowledge. I understand that this information is being used to determine eligibility for services. I acknowledge that providing false or misleading information may result in denial of services.
Signature
*
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