Financial Assistance Application I will bring proof of residence in Butts, Clayton, Coweta, Fayette, Heard, Henry, Lamar, Meriwether, Pike, Spalding Troup, or Upson counties. I understand HELP Spay/Neuter Clinic is limited to only residents in these counties. *(Required) I understand and agree to the above statement.Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Phone(Required)We will email you with an approval code, or other resources if we cannot approve you. Email Yearly HOUSEHOLD income (include everyone living in the house)Number of persons living within your household (adults and children)Funding assistance is only available to individuals with the following needs. Please check below, and bring to your appointment proof of all that apply to you. Social Security Medicare Unemployment Disability Food Stamps Low Income (see https://aspe.hhs.gov/poverty-guidelines) What kind of breed is your pet? (Dogs – Chihuahua, Boxer, etc.; Cats: short hair, medium hair, long hair, or a special breed?)(Required)If your pet is a pitbull or pitbull mix, please attach a photograph. Drop files here or Select files Max. file size: 128 MB, Max. files: 5. Pet One Information Male Dog Female Dog Male Cat Female Cat Pet one weight?Pet Two Information Male Dog Female Dog Male Cat Female Cat Pet two weight?Pet Three Information Male Dog Female Dog Male Cat Female Cat Pet three weight?I certify that the above referenced pet(s) are my own personal pet(s), I am the legal owner, and the pet(s) WILL NOT being rehomed. *(Required) I understand and agree to the above statement.I understand that completing this application does NOT guarantee funding assistance. I understand HELP processes requests in the order they are received, and according to when funding is available. WE ARE CURRENTLY REVIEWING AND MAKING DECISIONS WITHIN 30 BUSINESS DAYS. *(Required) I understand and agree to the above statement.If we schedule an appointment and you are unable to keep your appointment, you will have one chance to reschedule WITH notice. Any NO SHOW appointments will NOT be eligible for funding assistance. Once you have received approval, YOU HAVE TWO WEEKS TO MAKE CONTACT WITH US. This does NOT mean surgery will take place within two weeks, it means we will get you scheduled at our next available appointment. If we do not hear from you within two weeks, we will move to the next person and you will need to re-apply. *(Required) I understand and agree to the above statement.You consent to receiving calls, emails, and sms messages from HELP Spay Neuter Clinic. For more information, please review our privacy policy. Reply STOP to unsubscribe from SMS messages. Messaging and data rates may apply.(Required) I understand and agree to the above statement.CAPTCHA Δ
