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To be a model of excellence in the advancement of animal welfare

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Support for Pet Owners

Assistance Request Form

A completed and submitted request is required for consideration and does not guarantee financial assistance. Auburn Valley Humane Society (AVHS) cannot assist with already completed or paid services. Requests may take up to a week to process.

Financial assistance is limited to:

Medical Needs
Spay/neuter surgeries
Behavior support

It is your responsibility to seek immediate critical care for your pet if your pet is in an emergency where a delay will put its life at risk.

Auburn Valley Humane Society must approve all requests before services and/or supplies are rendered. Financial support is provided solely based on the availability of funding. We strongly recommend reaching out to other organizations for financial support as well.

Available funds are intended for income-qualified pet owners. Be prepared to provide proof of income qualification as it may be required in addition to your completed request form.

Owner's Name *

First Name

Last Name

Address *

City, State Zip *

Phone *

(###)

###

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Pet's Name *

Pet's Age *

Sex: *

Male

Female

Type: *

Dog

Cat

Other

Other:

Breed *

Color: *

Is Your Pet Spayed/Neutered: *

Is Your Pet Licensed? *

Agency & License #

Have you applied for Care Credit or Scratch Pay? *

Have you contacted other resources for assistance? If so, please list: *

Reason for assistance request *

Routine Veterinary Care

Non-routine Veterinary Care

Pet Spay/Neuter

Behavioral support

Describe in detail what your pet requires: *

My preferred method of contact is: *

Phone

Verify information *

By checking the box below that the information is correct and true to the best of my knowledge. I also understand by submitting this application I may not be granted funding through this program, and that this funding is only available one time per household. The Auburn Valley Humane Society has my permission to used provided photographs and information for promotional and grant reporting purposes.

Yes

No - your application will invalid if you click this

Thank you for submitting your Financial Assistance Request Form. Requests may take up to a week to process and the approval of any request will be dependent on the funding we have available at that time. We strongly recommend reaching out to other organizations for financial support as well.

The AVHS Special Programs Coordinator will reach out to you via your preferred method of contact with any questions or updates regarding your application. If you do not respond within 24 hours after AVHS contacts you, your application will be denied. If you have questions in the meantime, please email programs@auburnvalleyhs.org.