Animal Social Services Prototype Interest Form

Organization Info

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* 1. Organization Information

Your Name

Organization Name

Job Title

Jurisdiction (city, county, etc)

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Type of organization

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* 3. 2019 Data Annual Intake By Animal Type

Stray Dogs

Owner Surrendered Dogs

Stray Cats

Owner Surrendered Cats

Other (please describe)

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* 4. What is the human population of your jurisdiction?

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* 5. What is your annual budget?

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* 6. How many full-time staff equivalents do you have?

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* 7. How many volunteers do you have?

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* 8. How many foster homes do you have?

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* 9. Please describe what you think Animal Social Services is in your own words