The Elwood Grant- Veterinary Behaviorist 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. 

Are you willing to dedicate the time to follow the recommended protocols?  Circle One

Yes

No

 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 and Best Guess/Birthdate/Gotcha-Date

 ______________________________________

Is the dog Spayed/Neutered?

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

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: ____________________________________

Did a Veterinarian rule out medical reasons for change in behavior or aggression? Explain _____

Describe your dog’s behavior. Any details are helpful__________

Have there been any changes? New Home, New baby, Divorce, Job changes? _______

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

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

What is the relationship of the dog and the other animals in the home?

What is the relationship with the dog and the adults in the home? Children? Guests? Explain

Have you considered extreme measures such as euthanasia or surrender?

Why do you want to keep your pet? ___

What is a typical day in your household. How long in the dog alone, where do they eat, play, and sleep?

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? ______________

Can you afford future expenses such as medications or training? We can help you find affordable options if needed 

What amount can you pay for your pets 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

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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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