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    Pay It Forward Assistance Application V1-17-19


    Instructions:  Please respond to the following questions as specifically as possible.
    All information must be completed in full in order for the application to receive consideration. Each item marked with an *must be answered. 

    Important:  Click the pink button at the end of the application to send it to us.

    You will see this acknowledgement that your application has been submitted if it is sent properly: "Your information has been submitted. Please now send either a Facebook PM to Penny Standley, or an email to ourscottiesrock@gmail.com to let us know that you submitted an application so we can watch for it. (At times there are problems with transmissions.) Thank you!"


    Please Note the Following: 
    • Assistance is dependent on the need and the availability of Foundation funds.    
    • There will be a maximum allocation of $2,000 per household within a 12 month period.
    • The lifetime maximum household allocation is $5,000.

    Providing the requested information will allow the SRF Board to properly investigate the need, determine the veracity of the request, and evaluate the request based on its merits.  By providing this information, you are consenting to using it in the manner described. We value your privacy and will not disclose your information to any third party other than for verification of your request.   


    My typed signature below indicates my full understanding of the above statements,
    and of the accuracy of all of the information  contained in this application.

    Max file size: 20MB
    Select the desired file
    Max file size: 20MB
    Max file size: 20MB
    To successfully submit your application you MUST click the pink button below!! 
    Once submitted you see a brief message on the screen noting that your information was submitted.
    If you do not see that message, click the button again. 

Submit the Application
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  • Home
  • Vet Care Assistance
  • Donate
  • About Us
  • Meet the Team
  • Financial Information
  • 2023 Spring Auction
  • 2022 Business Partners
  • About Scotties
  • Scottie Health