SNAP Application

 

PLEASE FILL OUT THE FORM BELOW IF YOU ARE ALSO APPLYING FOR JAMAICA PLAINS' SHALIT-GLAZER CLINIC IN RESPONSE TO THE RECENT POSTING OF ADVERTISEMENTS ALONG BOSTON'S BUS ROUTES

SNAP is intended to assist low-income pet owners afford the cost of spaying or neutering their dog and/or cat. The Massachusetts Society for the Prevention of Cruelty to Animals (MSPCA) in cooperation with the Massachusetts Veterinary Medical Association (MVMA) offers eligible pet owners a discount on spay/neuter surgery. Reduced SNAP fees are made possible through generous donations of time and resources by participating veterinarians who believe in the importance of spaying and neutering as part of a complete pet healthcare program.

In order to apply for assistance, simply fill out this form completely, you will be notified about your eligibility for SNAP within 2 weeks of the time your application is received.

Purebred dogs and cats are generally ineligible for SNAP and applications are usually denied. Please call the office or include additional information in your application, if you think that your circumstances may warrant an exception. (617) 541-5007

You may only apply for your own dog and/or cat. If you have more than one pet that needs to be spayed or neutered, please include that information about the other pets that need assistance.

Please make sure your pet is up to date on necessary vaccinations (shots) PRIOR to the surgery. SNAP does NOT offer a discount on the fees for shots.

If you need help completing this form, please call (617) 541-5007. Incomplete applications will delay processing your request.

IMPORTANT

Please read before filling out application.

Please fill in all fields. If a field does not apply to you,  please type in "N/A" or "0". Applications take 2 weeks to process. Incomplete applications may take longer than 2 weeks to process.

1. Please complete the following:

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Name:

 

 

   

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City/State/ZIP:

 

    

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If you respond and have not already registered, you will receive periodic updates and communications from MSPCA-Angell.

 

What's this?

 

Please enter your total current household take-home pay (please enter a whole number with no decimal point or $ sign):

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Question - Required - Please check all of the public assistance programs in which you participate

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(Maximum response 255 chars, approx. 5 rows of text)

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  Household Members: Please list below all household members, INCLUDING YOURSELF, who rely on the above stated income. Indicate full-time (FT) or part-time (PT) for those employed; student, unemployed, retired, etc. where applicable.
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(Maximum response 255 chars, approx. 5 rows of text)

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  PLEASE ENTER INFORMATION ABOUT YOUR PET
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  What is your pet's age? If your pet is less than one year old, please just enter the number of months.
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  Is your pet up-to-date on the following shots?
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Question - Not Required - Rabies?




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Question - Not Required - For cats: FVRCP ("distemper"?)




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Question - Not Required - For dogs: DHLPP ("distemper"?)




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Question - Not Required - If you have a cat, do you let if go outdoors unsupervised?



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(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - I understand that the SNAP program is for low-income pet owners only. I certify that the information on this application is accurate. Please check "Yes" to indicate your signature.


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