Financial Assistance Application
Address including city, state and zip code
How did you hear about this program?
Pet's sex and altered status
If your pet is not already spayed or neutered, we may be able to help. Please list in notes section if needed.
Did you adopt your pet from HSWM?
If you adopted your pet from HSWM, you may be eligible for financial assistance from our Monica's Joy fund.
Please describe your pet's medical conditions and the care you believe (s)he needs. Please be specific and included all details that might be relevant.
In order to provide financial assistance, you must submit an estimate for future care or an invoice from the treating veterinarian. If you have not yet seen a vet and need financial assistance for an exam, please call at least two veterinarians for estimates.
I need funding to see a veterinarian for an exam
I have an estimate for future care
I have an invoice for care already received
Please note that we are unable to reimburse individuals; we can only submit a payment to a veterinarian or vet clinic.
If you already have an appointment scheduled for care, please list the veterinarian or vet clinic, date of appointment and approximate costs
Please let us know how you will submit your estimate or invoice. Please note that the shelter is currently open Wednesday & Friday-Sunday from 1-6pm, and our Clinic Coordinator is in Wednesday-Saturday.
Email to firstname.lastname@example.org(scanned copies, photos or emails from the vet are all acceptable).
Drop off in person at the shelter
Snail mail (not recommended but acceptable if the only option).
Are you participating in any federal or state financial assistance programs? Please select all that apply:
Medicare or Medicaid
WIC or Aid to Families with Dependent Children
Food Stamp Program
Other social supplemental benefits
Please let us know what other assistance you have requested or obtained.
AVMA fund (ask your vet)
Go Fund Me or other online donation fund
Please note that funds are limited and we strive to make the best use of the funding available. As a result, priority may be given to owners who are actively seeking funding from additional sources. Please visit myhswm.org/services/resources-links/ for additional financial assistance resources.
If you received financial assistance from other sources, please include the amount you received.
Please include any additional information that we should know about your pet or financial situation.
Our financial assistance program is entirely funded by donations and grants. Sharing stories of recipients and their pets helps us fundraise to keep offering this program. Would you be willing to be contacted by a member of our development team to share your story with our donors and grantors?