GOODS Program Application - Non-Rescue Animal Groups

The GOODS Program - Non-Rescue

Organization

Organization Type

Federal ID #

Website Address

Website link to adoptable animals, Do not put the word "Petfinder" or petfinder.com

Primary Contact Name

Applicant's Position in Organization

Phone Number

Street Address (No PO Boxes)

City

State

Zip Code

Number of active volunteers

Number of employees

Mission Statement

Describe Adoption Program

Does your organization have a contract to provide animal control services for any city, county, or municipality? If yes, please explain.

Veterinary Reference - Name, Phone Number, Contact Person, Address

Have you participated in a "donated" or "low cost" pet food program within the past 12 months?

If yes, please provide program name and frequency.

Why are you requesting support from Rescue Bank?

How did you hear about our program?

Reference 1: Name, Phone Number, and Relation to Group

Reference 2: Name, Phone Number, and Relation to Group

Interview Times

I have read and agree to the Terms and Conditions. (Will open a new window.)

Signature

Date