Apply for a Wheelchair Donation

This form is for wheelchair donation requests only. No financial assistance request will be considered. Please follow this link to address such needs: www.handicappedpets.com/pet-services/financial-aid-for-pets.

An application must be completed to be considered. Requesters must provide a picture of the pet in need and show financial need. Incomplete requests will not be considered.

Requests are reviewed once a month. You will be contacted at the end of the month whether your request has been accepted or denied. (*) means this is a mandatory field.

Your Information

Full Name(*)

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E-mail(*)

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Street Address(*)

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City(*)

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State(*)

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Zip(*)

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Phone(*)

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Your Pet Information

Pet Name(*)

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Species(*)

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Breed(*)

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Age(*)

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Weight(*)

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Gender

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Attach a photo of your pet's condition (*)

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Pet Health Information

Describe Pet's overall health(*)

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Cause of mobility loss(*)

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Describe pet's condition and length of time disabled (*)

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What is the veterinarian's diagnosis, prognosis or recommendations? (*)

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List the specifics of what your pet needs (*)

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Is there anything else you'd like us to consider as we review your application?

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Proof of Hardship (*)

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In order to make sure that our assistance goes to the families who need it the most, we ask that you show us that you are already receiving assistance/support from state or local government assistance programs. Proof of financial hardship involves a document with the pet owners name and address on it, that shows you are getting state aid or assistance. Among such programs include disability, welfare, food stamps, section 8 housing assistance, TANF, SSI, unemployment, and more. Please upload a scan or photograph the document or mail a copy to our address (copies will not be returned).

Applications are reviewed once a month; all applicants will be promptly notified by email whether they have been denied or awarded a wheelchair grant.

NOTE:

Wheelchair grants will be held for 7 days from the date of the award email; if not ordered during that time the grant will be awarded to another applicant.
We do not hold request from month to month
Shipping to recipients outside of the USA/North America will be the responsibility of the recipient.

Applications are reviewed 3-4 times a month; all applicants are promptly notified by email whether they have been denied or awarded a wheelchair grant.

Wheelchair grants will be held for 7 days; if not ordered during that time the grant will be awarded to another applicant.

(*)

I give Handicapped Pets Foundation permission to publish any pet photos or videos I submit in any and all of its printed or web-based publications without compensation. Invalid Input