Canine Scholarship & Temporary Housing Application
Apply for temporary housing or training support for a dog. The form also includes an optional way to express interest in donating money, supplies, or volunteering. Please complete the information that applies to your situation.
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
Dog Info
Dog Name
*
Breed
*
Age (Years)
*
Sex
*
Male
Female
Unknown
Size
*
Please Select
Small
Medium
Large
Extra Large
Unknown
Temporary Housing
Do you need foster or temporary care for your dog?
*
Yes
No
When would temporary housing be needed?
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Why do you need temporary housing?
What support or care instructions should the temporary home know?
Training Aid
Type of Training Aid Needed
*
Financial support
Training
Food or supply assistance
Other
Requested Financial Support Percent (if applicable)
In-Kind Training Support Needed (If applicable.)
Training sessions
Training equipment
Behavior consultation
Board-and-train assistance
Other
Additional Details About Training Support Need
Food & Medical Care
Current diet and feeding schedule
Food allergies or sensitivities
Current medications and dosages
Veterinarian contact name
First Name
Middle Name
Last Name
Veterinarian phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Vaccination status
Please Select
Up to date
Not up to date
Unknown
Estimated monthly food and medical costs
Optional Donation Interest
Some of our applicants are able to donate time, supplies or make small financial donations. If this is not your situation thats fine! Please, don't feel pressured.
How would you like to support the program?
Money
Supplies
Volunteering
Other
If donating supplies, what items are you considering?
If interested in volunteering, please share your availability or preferred ways to help.
Sign & Submit
By signing you swear that the information above is true to the best of your knowledge and that you understand that this is an application for assistance and is not a guarantee or promise of services, aid, or in any way a transactional agreement.
Signature
Submit Application
Submit Application
Applicant Info
Should be Empty: