Application for Assistance

Before you begin please gather the following information for use in your application.

  • Your Driver’s License number
  • Your Social Security number
  • Contact information for 1 personal reference
  • Your Veterinarian’s name and contact Information
  • Dates of your pet’s last vaccinations
  • Income information for each member of your household

Please fill out all information or your application will not be considered.

You can also download the printable form in English or Spanish and send it to info@animalwelfare.com for consideration.

 

About You

About Your Veterinarian

Do we have your permission to get records from your veterinarian?

Personal Reference

This person is my:

Information About Your Pet

My pet is a:

Sex

Is the pet spayed or neutered?

Is the pet microchipped?

Where did you get the pet?

Has the pet had this problem before?

Has the pet had surgery before?

Financial Information

Have you received assistance from Animal Welfare Assistance Group (formerly AWIA) in the past?

If yes, Was it for the same animal that you are currently applying for?

What type of assistance did you receive?

Have you applied for Care Credit?

This is a requirement before receiving assistance from AWAG. We will need a copy of your denial letter or to know the amount you were approved for by Care Credit. To apply online go to www.carecredit.com or call 1-800-677-0718.

Have you applied with any other agencies for assistance?

Are you currently employed?

Do you own your own home or are making payments on a mortgage?

Do any of the adults have any investments or own any property?

Are you a disabled veteran?

Is your dog a trained service animal?

Do you currently receive Cal Fresh of SNAP (Food Stamps)?

Are you currently receiving Social Security Disability or SSI?

Administration

In the event you receive assistance from AWAG, will you agree to allow AWAG to use your pets name, photo and story in any way (such as on the website, in our newsletter, etc.)?

How did you hear about us?

Digital Signature