Spay & Neuter Angel Program (SNAP) Application

YOUR INFORMATION

All information received will remain confidential.

Required: *Phone number with a working voicemail through which we will contact you regarding this application and through which you will be readily available while your pets are at Tails of Hope. *Active email address for follow-up and transmission of application documents.

Once approved and appointment is made, applicant will need to be present at appointment for pet admission.

Question Title

* 1. YOUR CONTACT INFORMATION: Where you live with your pets. (P.O. Boxes not allowed.)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. I currently:

Own my home

Rent my home

Live in public housing

Live with family

Question Title

* 3. Are you currently employed?

Yes, Full-time

Yes, Part-time

Yes, Self-employed

No, I am Retired

No, I am not currently employed

Question Title

* 4. Check all of the following benefits that you or someone in your household are currently receiving:

SNAP (Supplemental Nutrition Assistance Program)

Medical Benefits

Social Security Disability

SSI

Section 8

WIC (Women, Infants, and Children)

LIHEAP - PA (Low Income Home Energy Assistance Program)

PIPP - OH (Percentage of Income Payment Plan)

Military (Note: TOH's Military Discount cannot be combined with any other program discounts.)

Other (please specify)