The Bo Grant- Medical Grant For Non - Urgent, Non-Basic Veterinary Expenses Bo Paws It Forward Inc DOES NOT discriminate on the basis of age, gender, sexual orientation, race or disability. Bo Paws It Forward reserves the right to deny funding or any reason. Please read the application agreement for details of the application and selection process. Pronouns Preferred Name * First Name Last Name Applicant Phone Number * (###) ### #### Email * Address * Own , Rent or Other * Own Rent Other Additional Phone Number Are you a breeder? * Yes No Dogs Name * Dogs Breed * First Consideration is given to Mastiff Breeds and Pit Bulls but we award on a case by case basis so all breeds are welcome to apply How long have you had the dog and where did you get the animal? * Dogs Age * Birthdate-Gotcha Date or best guess Is Dog Spayed/Neutered? * Unless an approved reason is given - all dogs must be spayed or neutered to receive grants or must agree to be altered when medically cleared If Dog is NOT spayed or neutered; explain why * If Approved by the treating Veterinarian- Do You agree to have the animal spayed/neutered? * This is a requirement for consideration of grants Yes No Treating Veterinarian Name * Clinic Name * Clinic Phone Number * (###) ### #### Treating Veterinarian Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Clinic Email Pets Medical Needs-please be specific * Will the animal have future medical needs such as medication, future surgeries or physical therapy? * Medical history of the dog being treated * What is the High and Low End estimate for treatment? * List all other animals in the home-Names, Age, Species, How /where they were obtained and if they are spayed and neutered * How many adults in the household? * How many children under 18 live in the home? * What is the annual household income? * Please include income of all adults What circumstances are keeping the applicant from affording the recommended treatment? * Proof Of Income is required- Select one of the following * Copy of most recent Pay stub SSU/SSDI/SSA Benefits letter Proof of any Federal or state assistance Unemployment Benefits Letter W-2 or 1099 From Employer Select one option that applies to the applicant * Unemployment Disabled 65 or Over Military Veteran/Active Military/ Military Spouse Temporary Hardship None If You selected Temporary Hardship- Please explain the circumstances and how this impacts your ability to pay for Veterinary treatments We give priority to applicants with limited or low income but we do make special considerations on case by case basis for all income levels. Do You Consent for volunteers/staff of Bo Paws It Forward to discuss medical and financial matters with your treating vet? * We must have permission to consider grant awards Yes No Applied For Care Credit? * Must Provide proof of approval with amount available or proof of denial of credit Yes No Have You applied to other organizations or created a crowd funding page? Please include any links applicable? * What amount can you pay towards your dogs treatment at this time? * I have read and agree to the grant qualifications. By submitting this application, I agree that it has been completed to the best of my knowledge. I understand that incomplete and/or submission of false information may result in an application being denied. * This field acts as a signature of agreement. It is a required field. I Agree I agree to allow Bo Paws It Forward to use photos and information for promotion or social media * We will protect your identity by changing names and only revealing necessary information. Your story is vital to carrying out our work so we can show generous donors what we do and who benefits. This is a requirement to be considered. Yes, I agree No, I Decline Thank you for your submission.. Please send all required forms of proof (income, Vet records etc ) to bopawsitforward@gmail.com. Once all information has been submitted please give us 24 hours. We will contact you with our decision by either phone or email regardless of our decision.