Apply for Assistance

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💕👉ACAP REQUIRES THAT YOUR PETS BE SPAYED (FEMALES) OR NEUTERED (MALES). IF THEY ARE NOT SPAYED/NEUTERED AT THE TIME YOU APPLY FOR ASSISTANCE, WE HAVE FUNDING TO HELP WITH THE COST.👈💕

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Apply for Assistance:

* Indicates required field

Name *

First

Last

Applicant should be the owner of the pet(s) seeking assistance

Phone (please include area code) *

Address (include city & state) *

What City, County or Town do you live in? ACAP assists residents of the following VA locations: *

Email *

Have we helped you before? *

Yes No

If "yes" who and when did we help? *

How many Dogs do you have? *

How many Cats do you have? *

Are they ALL spayed/neutered? *

Yes, all of my pets are spayed/neutered No, none of my pets are spayed/neutered Some of my pets are spayed/neutered I'm not sure

If "no" do you agree to spay/neuter your pet(s)? *

Yes No All of my pets are already spayed/neutered

Where did you get your pet & how long have you had him/her? *

Financial Qualifications

ACAP is a low income based program. Please answer the following questions to see if you qualify: *

Do you work? *

Yes (Full Time) Yes (Part Time) I'm getting unemployment benefits I'm disabled (receiving disability) I'm retired (receiving social security and/or pension) My spouse/partner works, I stay home I do not work

What is your MONTHLY income? *

How many people live on this income? *

Please provide proof of your income (picture of SNAP/MEDICAID/TANF/SSDI/SSI/Spousal/child support card or letter OR PAYSTUB) *

Max file size: 20MB

Do you own, rent, or live with friends/family? *

Own Rent Live with friends/family

How much rent/mortgage do you pay monthly? *

Tell Us About Your Pets

PET #1 NAME *

Cat or Dog? *

Cat Dog

How old is your pet? *

What BREED and COLOR is your pet? (EX cats: short or long hair, grey tabby; EX dogs: brown beagle mix) *

What WEIGHT is your pet? (you can estimate) *

Spayed (Females) or Neutered (Males)? *

Yes No I'm not sure

Last time seen by a vet? *

Does this pet have a current rabies vaccine? *

Yes No I don't know

Upload a photo of this pet here (or email it to apply@acapva.org or text it to 540-850-2680) *

Max file size: 20MB

*you can text a photo to our phone @ 540-850-2680

What vet care does your pet need? *

PET #2 NAME (skip this section if you only have 1 pet) *

Cat or Dog? *

Cat Dog

How old is your pet? *

What BREED and COLOR is your pet? (EX cats: short or long hair, grey tabby; EX dogs: brown beagle mix) *

What WEIGHT is your pet? (you can estimate) *

Spayed (Females) or Neutered (Males)? *

Yes No I'm not sure

Last time seen by a vet? *

Does this pet have a current rabies vaccine? *

Yes No I don't know

Upload a photo of this pet here (or email it to apply@acapva.org or text it to 540-850-2680) *

Max file size: 20MB

What vet care does your pet need? *

PET #3 NAME *

Cat or Dog? *

Cat Dog

How old is your pet? *

What BREED and COLOR is your pet? (EX cats: short or long hair, grey tabby; EX dogs: brown beagle mix) *

What WEIGHT is your pet? (you can estimate) *

Spayed (Females) or Neutered (Males)? *

Yes No I'm not sure

Last time seen by a vet? *

Does your pet have a current rabies vaccine? *

Yes No I don't know

Upload a photo of this pet here (or email it to apply@acapva.org or text it to 540-850-2680) *

Max file size: 20MB

What vet care does your pet need? *

Is there anything else you need help with? *

Please add any additional information here: *

I certify that I have read and understand all of the terms of this application and that all of the information I have provided is true. I certify that I am the owner of this animal. I understand that ACAP will help with a portion or all of the veterinary expenses and that I will be responsible for any outstanding balance over and above ACAP's approved donation amount. I have been informed that ACAP's typical donation amount does not exceed $200-$300 and that I will be responsible for any balance beyond that. I agree to allow ACAP to share some of my information with other sources, such as veterinary clinics, etc, and that they may use my pet's photos on their social media pages. ACAP respects my privacy and will not identify me or my pet in their posts. If my pet hasn't been spayed at the time of ACAP's donation, I agree to have my pet spayed/neutered once his health has been cleared by a veterinarian. I understand that ACAP may have funds to help me with the cost of spaying/neutering my pets. If an ACAP volunteer has completed this application for me over the phone, I give him/her permission to agree to these terms and electronically sign this application. *

Yes, I understand and agree to these terms

Name (this will serve as my electronic signature) *

First

Last

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Please type the YEAR of your birth *

Submit

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