Live for David Grant for Emergency Veterinary Assistance

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Personal Information

* First name

* Last name

* Email

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Home phone

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* Current Address

Current Address 2

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*State/Province

Applicant Eligibility Requirements

This application is for the ResQ Fund's Live for David Grant only. If this request is for non-emergency assistance for spay/neuter and vaccines, please return to our website and use the appropriate link.

IF YOUR PET IS HAVING AN EMERGENCY OR LIFE THREATENING ISSUE, PLEASE SEEK IMMEDIATE ATTENTION! THIS FUND MAY NOT BE IMMEDIATELY AVAILABLE.

The ResQ Fund is currently only available to pet owners living in the counties that compromise the Eastern Panhandle of West Virginia and to rescues that serve and help our area. If you do not live in Berkeley, Jefferson, Grant, Hardy, Morgan, Hampshire, Mineral, or Pendleton county, please refer to our website for links to other organizations that may be able to assist you.

The following application is for individuals seeking financial aid from To The ResQ's Live for David grant program for veterinary aid for life-threatening illnesses and/or emergencies. A maximum grant of $250 per incident/illness per pet may be available through this program. All funds will be paid directly to a veterinary practice. No funds will be given directly to an individual. Please be truthful and accurate in answering all questions in this application. Any deliberate misrepresentations or falsehoods may affect your eligibility for assistance.

To The ResQ does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.

Please explain your current situation and why you are requesting financial assistance through the ResQ Fund.

Please include information regarding your current job status (unemployed, employed, retired, student, part-time, disability etc.) or recent change(s) to your income which have led you to need assistance at this time.

Please check answer which best describes your current employment status:

Employed full-timeEmployed part-timeRetiredStudentUnemployedUnable to Work, Receiving Disability/SSI

Do you currently receive any Human Social Service Assistance? Check all that apply:

Be prepared to provide proof of government assistance. This will expedite the application process.

SNAPDisability/SSIMedicaidUnemploymentWICI am currently not receiving any assistance, but am suffering financial hardship.

If you are receiving any of the benefits referenced above, please upload one document showing proof of financial need, such as unemployment status, disability, social security, SNAP benefits, etc.

If you indicated above that you are receiving social services in the question above, you will be asked to provide proof before being approved so please upload documents. This may fast-track your application. All information will be held confidentially.

Have you applied for and received Care Credit? Applying to Care Credit (carecredit.com or 800-677-0718) is an eligibility requirement for help with personal pets. (If you are applying for a stray or an animal that does not belong to you, please check the appropriate box.)

DO NOT SKIP THIS STEP! If you are applying for your own personal pet, your application will be REJECTED if you have not applied for Care Credit. Be prepared to show proof of your application approval/denial. You will be asked to show a screen shot of your application status. NO APPLICATIONS WILL BE PROCESSED WITHOUT APPLYING FOR CARE CREDIT FIRST - even if you decide not to take the loan.

Yes, I have applied, but was denied Care Credit.No, I have not applied for Care Credit at this time. (Checking no will automatically REJECT your application.) Yes, I have applied and was approved, but it is still a hardship for me to pay.No. This animal does not belong to me and is not my personal pet.

Please upload a copy of your approval/denial from Care Credit.

Applicants must make an attempt to apply for Care Credit before we can approve an application.

On your application for Care Credit, you were asked to indicate your monthly income. Which range below best reflects the number you used to indicate your monthly income from all sources in your household?

Proof of income may be requested. Please note, the totality of your circumstances will be considered when determining your eligibility for aid.

$0 to $1000 monthly income$1001 to $2500 monthly income$2501 to $4000 monthly income$4001 to $5500 monthly income$5501 to $7000 monthly income$7001 to $8500 monthly incomeOver $8500 monthly incomeI did not apply for Care Credit.

Please enter the total number of persons in your household for whom you are responsible, including yourself.

What is your family size?

Is there anything you would like to share with us about your pet or why you need our help that you feel would be beneficial for our decision team to know when deciding your application?

We aren’t always able to award 100% of the costs of services needed. For some awards, we may only approve a
partial award. Are you willing or able to contribute a small percentage towards these services? If so, how much can you afford at the moment?

It is beneficial for our team to know that you are willing to contribute a portion of the expenses, either now or in the future.

Information about the Animal in Need

Please provide details on the pet or animal that requires assistance.

What is the pet's name?

Is this animal owned by you, another person, a rescue, or is this a stray/feral animal?

How can the ResQ Fund help?

Please answer the following questions completely to ensure your application is submitted correctly and not rejected.

Please let us know in the space below the total number of pets in your household. Please include ALL the pets in your household.

For example, 2 dogs, 4 cats, 2 birds, etc.

Provide the following information regarding the pet(s) for which you are applying for assistance: Type/Name/Sex/Medical Needs . Please be as specific as possible with what your pet's current issues are.

Example: Dog/Fido/Male/dental issues or Cat/Patches/Female/vomiting, emergency, issue unknown

For what type of medical services do you require assistance? Please check all that apply.

Life-Threatening Emergency Aid Minor Illness (upper respiratory, vomiting, urinary problems)Dental IssuesSurgery (enucleation, limb amputation, hernia repair, etc.)Other

If you have already received a copy of a written cost estimate for the needed procedures and/or treatment from your veterinarian, please upload here.

All pets must be living in a healthy environment and good living conditions. Please check the answer that best represents your pet's living environment.

My pets live inside only. My pets live inside and outside. My pets live outside only. This is for a stray animal living outside that does not belong to me.

Are all of your pets up to date on rabies vaccinations? Please be prepared to present proof of rabies vaccines.

Some of my pets are not up to date on rabies vaccinations.Yes, my pets are up to date on rabies vaccinations.No, none of my pet(s) are up to date on rabies vaccinations.

To be approved to receive ResQ Funds, we require all pets in your household to be spayed/neutered, unless there is a compelling reason why they cannot be. Please check the answer below that best applies to your situation.

If some of your pets are not spayed/neutered, as a condition for being approved for this grant, you will be asked to commit to having all of our pets spayed and neutered. Additional funds may be made available to you for this purpose.

All of my pets are spayed/neutered.Some of my pets are not spayed/neutered, but I plan to have them spayed/neutered.Some of my pets are not spayed/neutered, and I do not intend to spay/neuter them. One or more of my pets are not spayed/neutered because my vet advised against it for medical reasons.

Are all of your pets for companionship and not used for breeding or illegal activities? Please explain if any of your pets are used for breeding or sport/entertainment purposes.

Please use the space below to share any additional information that you would like for the ResQ Fund Decision team to know when considering your application. If you have any questions, please also include them here.

If you do not receive help with your pet(s), what will you do?

I will surrender my pet(s) to our local shelter, because I will be unable to care for them.I will look for a rescue that can provide medical care for them, because I will be unable to care for them.I would consider euthanizing them because I have no other means to pay for their medical care.I will keep looking for ways to help them so that I can get them well and keep them.

Will you need help with transporting your pets to and from vet for care?

Please check yes if you need to use our ResQ Shuttle service to transport your pets to the vet. Our ResQ Shuttle Manager will be in touch. You will also need to sign a release of liability form to use the ResQ Shuttle.

Yes, I will need help taking my pets to and/or from the vet. No, I can provide my own transportation.I am not sure. I may be able to take them depending on where and time of day.

When your situation improves would you consider contributing back to the ResQ Fund to help others?

Agreements and/or Acknowledgements

Please read and consent to the following.

May we text you?

YesNo

Do you object to having your name checked through the local court system?

YesNo

If you have a veterinarian, do you give us permission to contact them for a reference, if one is needed. If yes, please enter the name and telephone number of the veterinary practice that you are currently using.

If you do not have a veterinarian, please indicate below.

Please indicate your agreement to the following: I understand that the ResQ Fund grant and donations may not cover all veterinary charges for my pet's care. If donations from the ResQ Fund are insufficient to cover the entirety of my pet's charges, I understand that these charges are my financial responsibility, and not that of The ResQ Fund or To The ResQ.

The ResQ Fund program will attempt to raise the funds needed for your pet, but can only guarantee the $250 Live for David grant, if awarded.

Yes, I understand that I am responsible for all charges for my pet's care.No, I do not accept ultimate financial responsibility for my pet's bills.

By signing below, I certify that the above information is true and I understand that providing false information may result in nullifying this application. I understand that this application does not constitute that any services will be rendered. I understand The ResQ Fund has the right to deny any application. I hereby release To The ResQ, The ResQ Fund and all representatives associated herein from any and all liability related to any services obtained in connection to this request for funding. Typing my full name below serves as my digital signature and my agreement to the ResQ Fund requirements and my certification of truthfulness of the statements I have made above.

Example: John Edward Smith

Please enter today's date below.

Example: December 10, 2022

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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