Application — The Karen Hartwig Foundation

Please review the Application Requirements below before completing the application form below. Once you have completed the application, click the 'Submit Application' button and your application will automatically be submitted. Applications will take 24-28 hours to review.

Please visit the Animal Resource Link page for additional groups that may be able to assist.

To submit a paper application, please click the document below and submit via email tori@victoriconstruction.com.
Guardian Angel Relief Application

Applicant Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

How many people in the household?

Have you ever received a grant from us? If yes, when?

Is the animal in custody of a rescue group? If yes, who?

About the Animal In Need

Animal Name

Date the applicant assumed responsibility of the animal:

YYYY

Species

Breed

Age

Gender

Spayed/Neutered

Name of primary Veterinary

Is the animal current on vaccinations? If not, what is needed?

Describe the applicant's relationship with this animal:

If this is a medical emergency, please describe any treatment that has already been provided

Please list all other pets in the home including for each animal Name/Species/Breed/Gender/Age/Spayed or Neutered/Current on Vaccinations:

Assistance Being Sought

Describe the type of assistance being sought (ex. financial hardship)

Veterinarian's Diagnosis and Recommended Course of Treatment

What is the estimated total cost to address the situation (in U.S. Dollars)?

How much is the applicant able to personally contribute toward resolution of the situation (in U.S. Dollars)?

Has the applicant applied for grants from other organizations? If yes, which ones?

Please list all donations received toward resolution of the situation, including name of organization, date and the amount of donation:

Date by which assistance is needed:

YYYY

If you created an online fundraiser, please list the web link here

How did you hear about the Karen Hartwig Foundation?

Please add any other information that the applicant would like to share about the situation

Disclaimer and Signature:
By submitting this application to the Karen Hartwig Foundation, I hereby certify that all of the information above is to the best of my knowledge and belief true, correct, and complete. I have read and hereby agree to abide by all the terms and conditions stated in the Application Requirements. I understand that if I breach any terms of this application, all funds must be returned in full to The Karen Hartwig Foundation

Guardian Angel Relief Grant Application Requirements:

The deserving pet owner must:

· be seeking financial assistance in order to maintain permanent ownership of a family pet (for example, assistance with unexpected medical bills, pet deposits for rented homes) or to keep animals out of shelters in some other manner (for example, low cost spay/neuter for free roaming cats)

· be willing to allow representatives of the Karen Hartwig Foundation to communicate directly with involved 3rd parties such as veterinarians or landlords

· be willing to demonstrate a financial need by providing documentary proof of current wages, employment or unemployment status, disability, or other evidence of financial stress

· provide updates, photos or videos to document the pet’s progress and be willing to share agreed‐upon information publicly

· be willing to submit to a home visit

· be willing to supply personal references upon request

· not be a recipient of a Karen Hartwig Foundation Grant within the current calendar year

The deserving pet must:

· be in imminent danger of being removed from the home due to the financial circumstances of its owner (ex. Life-threatening injury or illness requiring urgent treatment, pet deposit to secure housing…)

· up to date on vaccinations (provide proof)

· be spayed or neutered; or the owner must be willing to accept assistance to alter the animal

· In the case of medical emergency, the animal must have a favorable prognosis and not have a chronic, ongoing condition such as diabetes or cancer

The involved veterinary clinic/landlord/3rd party must:

· be aware of the owner’s financial need

· be willing to speak directly with a representative of the Karen Hartwig Foundation

· be willing to provide an itemized estimate of the cost of resolving the situation (vet estimate, pet deposit, etc.)