Financial Assistance Grant Application


Your application WILL ONLY BE CONSIDERED if you & all adult members of your household:

 Are a resident(s) of Monterey or Santa Cruz counties;

Are at or below 250% of the federal poverty level;

Email 3 months of bank statements;

Email additional proof of financial need;

Email Proof of Care Credit approval/denial;

Email pictures of the pet who is in need. 

Called the Help Line: (831) 471-7912 and email help@birchbarkfoundation.org upon submission of the below application.


The following criteria is mandatory to apply for BirchBark Foundation funding:

  • BirchBark Foundation is only able to grant assistance to cases treated at one of our Associate Member Hospitals for a life-threatening or life compromising situation with a good prognosis. We do not fund routine care.
     
  • BirchBark does not provide any funding for medical services that have already been rendered. A grant application does not guarantee funding. Your application and treatment estimates must be approved for funding by our review board prior to the animal receiving the applied for treatment.
     
  • If approved, BirchBark provides funding for up to 50% of the bill and Associate Member hospitals discount 25% from their services. The owner will have to use the entire amount of Care Credit towards the pet's treatment. The owner and hospital must come to a payment agreement for the client's portion of the bill.
     
  • All animals that receive BirchBark funding must be spayed or neutered. If an animal is not spayed/neutered at the time funding is given, the owner will agree to have their animal sterilized within a set time frame determined by the treating veterinarian (based on the health of the animal).
     
  • All recipients of BirchBark funding agree to allow BirchBark to use their story, photos and video. BirchBark requests that owners provide photographs of their pets to the BirchBark Foundation. BirchBark will send a representative to take photos and write up your story for our donors to learn about the successful outcome for your pet.
     
  • Recipients are asked to do whatever possible to help BirchBark save other family pets. This includes sending an e-mail to family and friends, volunteering when possible and participating in special events.

I have read and agree to the grant qualifications. By submitting this application, I agree that it has been completed in good faith. I understand that incomplete applications and/or the submission of false information may result in my application being denied.

Once your application, financial information, and treatment estimates are received, BirchBark representatives will review the application and request any additional information that is needed.

Next, the application will be forwarded to the BirchBark veterinary review board and grants committee where it will be considered based on criteria including, but not limited to, the following:

  1. Treatment must be for a life-threatening condition.
  2. Prognosis of the patient must be good to excellent.
  3. Owner’s financial hardship and capability of caring for the pet post op.
  4. BirchBark will do its best to render a response within 3 hours of submitting an application to our granting committee.

*Do NOT refresh the page as you are working, it does NOT save as you go!*

Once you click submit, please call the Help Line to notify BirchBark of your incoming documents.

You MUST
email picture of your pet, financial documents, treatment plan and estimates to help@birchbarkfoundation.org

Your application is NOT CONSIDERED complete until we receive ALL additional attached documents. 

Help Line: (831) 471-7912


About the Applicant
First Name, Last Name *
First Name, Last Name
Phone *
Phone
Is there an alternate contact for this case? *
Alternate Contact Name
Alternate Contact Name
Additional Phone
Additional Phone
You must provide the name of the vet or practice your pet is usually seen.
Regular Vet or Vet Clinic Phone Number *
Regular Vet or Vet Clinic Phone Number
You must provide the phone number of your pet's regular clinic. We will need this to call for records.
Please write your place of employment (if none, write n/a)
Please provide the name of your supervisor and their contact information (if unemployed, write n/a)
Has the applicant ever received a BirchBark financial assistance grant? *
Is the applicant applying again for a grant request that was previously denied? *
Please type a number
Which of the following 2 items will the applicant provide as proof of income (in addition to last 3 months bank statements)? *
Please email to help@birchbarkfoundation.org - required for application to be considered complete.
Which of the following apply for the applicant? (Please check all that apply.) *
Has the applicant applied for Care Credit? This is a requirement to apply for assistance. *
Please email a copy to: help@birchbarkfoundation.org
About the Animal
Sex *
Spayed or Neutered *
When did the animal join the applicant’s household? *
When did the animal join the applicant’s household?
Is the animal certified as a therapy pet?
About the Animal's Injury or Illness and Treatment
Has a veterinarian seen this animal for this injury or illness within the last 30 days? *
When did this injury/illness first occur? *
When did this injury/illness first occur?
Application will not be considered complete unless records are emailed to: please send all records to help@birchbarkfoundation.org
According to the veterinarian, will the animal die, have a significant compromise to its life or need to be euthanizedwithin a week if not treated? *
Is the animal at the hospital now? *
Does the estimate of upcoming treatment include both a low end and a high-end amount? *
$
BirchBark Foundation assistance can help with funds after your resources have been used including Care Credit, retirement funds, savings, loans from friends and family.
$
Has the applicant applied for help with other organizations? *
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About the Clinic Treating the Animal
Clinic Address
Clinic Address
Clinic Phone *
Clinic Phone
Clinic Fax
Clinic Fax
Contact Name
Contact Name

Once you click submit please email financial documents, Care Credit Approval/Denial, and pictures of your pet to  help@birchbarkfoundation.org
Your application is NOT CONSIDERED complete until we receive ALL additional attached documents. 

Call the help line at 831-471-7912 to notify us of your completed submission. Someone will get back to you shortly.