Placement Partner Application

Agency/Organization Name:

Agency Website:

Agency Phone Number:

Agency Email Address:

Physical Address:

Mailing Address:

Primary Contact Person Name and Title:

Primary Contact Person Email:

Primary Contact Person Phone Number:

Shelter Director (if different from above):

Shelter Director Phone Number and Email Address:

Is your agency (Please check all that apply):

When was your organization established?

What is your agency's mission/reason for being?

What species of animals are you interested in assisting with?

How do you plan to transport the animals to your organization?

What types of animals are you willing to help with placement? Ex: underage kittens, FIV cats, puppies, dogs with a specific behavior issue. If behavior specific, please specify.

How do animals enter your shelter (owner surrender/stray/transfer)? What is the percentage breakdown of each?

Are you currently transferring animals in/out with other organizations? If yes, which agency(s):

Please describe your behavior evaluation process for dogs:

Which behavior issues does your organization feel comfortable working with and placing up for adoption?

Which behavior problems would exclude an animal from being placed for adoption?

Please provide names of 3 established transfer partner organizations. If you have less than three partners, please list the ones you do have:

Please provide the name and phone number of your primary veterinarian:

May we contact the agencies listed above for a reference?

What were your Animal Intakes for the Most Recent Calendar Year?

What were your Number of animals transferred to other agencies for the Most Recent Calendar Year?

What were your Number of animals euthanized for the Most Recent Calendar Year?

What Live Release Rate % for the Most Recent Calendar Year? (Live Releases/Total Outcomes)

What were your Animal Intakes for the Prior Calendar Year?

What were your Number of animals transferred to other agencies for the Prior Calendar Year?

Number of animals euthanized for the Prior Calendar Year?

What Live Release Rate % for the Prior Calendar Year? (Live Releases/Total Outcomes)

Where are your animals housed?

Please elaborate on how the animals are housed in each situation above.

What is your housing capacity for dogs?

What is your housing capacity for cats?

Do you have a veterinarian on site?

If yes, what is the veterinarians name and phone:

If you don't have a veterinarian onsite, do you have a veterinarian that routinely visits your facility or do you transport to a clinic?

If yes, how often and why? Please provide vet/clinic name and phone:

Routine medical care includes vaccines on intake?

If yes, which vaccines?

Are animals in your care given the following items?

What is your policy on spaying and neutering?

What are common conditions and illnesses seen in your organization? Ex: ringworm, coccida, kennel cough, Parvo, URI?

If you are located outside of Washington, are USDA Health Certificates/Rabies/Heartworm testing necessary for animals prior to transport?

What is your policy on Microchipping?