The Bo Grant- Medical Grant For Non-urgent, Non Basic Veterinary Expenses Application 

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 for any reason. Please read the application agreement for details about the application and selection process. 

Pronouns Preferred:

 First Name                                          Last Name

Email Address:

 Address:

Rent or own or if other please explain:

______________________________

Alternative Phone Number:

______________________________

Are You a Breeder? Circle one

 Yes

No

Dog’s Name                                           

___________________________       

Dog’s Breed_______________

How Long have you had the dog and where did you get the animal?

Dog’s Age-Best Guess/Birthdate/Gotcha-Date

 _____________________________________

Is the dog Spayed/Neutered? Circle one

(Unless an approved reason is given – to be considered all dogs must be spayed/neutered or guardian agrees for the animal to be altered) 

Yes

No

 If dog is NOT Spayed/Neutered- explain why

 If approved by the treating veterinarian- Do you agree to have the dog spayed/neutered? Circle One

Yes

No

Treating Veterinarian Name                      

 ________________________    

    Clinic Name       ____________________________________________

Clinic Phone Number: __________________  

Clinic Address:

Clinic Email: ____________________________________

Pets Medical Needs- Be Specific 

Will the animal have future needs such as medication, future surgeries or physical therapy? Please explain

Medical History of Dog being treated ( Past surgeries, wellness visits, dentals etc) 

What is the high and low end estimate for treatment?

 List all other animals in the home- Name, Age, Species, how they were obtained are they spayed/neutered?

How Many adults in the household?           

 ____________________________                  

 How Many children under 18 live in the home?________

What is the household income? ( please include income of all adults in the home)

 __________________________

What circumstances are keeping the applicant from affording treatment?

If you are facing temporary hardship- Please explain ( we give priority to applicants with limited or low income but we make special considerations on a case by case basis for all income levels facing a need)

Do you consent for volunteers/staff of Bo Paws It Forward to discuss medical and financial matters with your treating Vet?

 Have You applied for CareCredit? ______________

Have you applied for funding with other organizations or created a crowd funding page? Please include links if possible

What amount can you pay towards your dogs treatment at this time? $__________________

Please include proof of income- ( SSU/SSA/SSDI Benefits Letter- Pay Stub- W2 or letter of income from employer- Unemployment Benefits Letter- Proof of any federal assistance ) 

Are you any of the following? Please Circle 

Unemployed     Over 65 yrs.      Disabled      Military Veteran/Active Duty/Military Spouse 

I have read and agree to the grant qualifications. By Signing and submitting this application, I agree 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

Sign                                                                                         Date

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 from our services. This is a requirement for consideration. )

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