Scotties Rock Foundation
Our Scotties ROCK!!
Vet Care Assistance
Meet the Team
Business Partners 2020
Scotties Rock Foundation, Inc.
A 501(c)3 Non-profit Charitable Organization
Pay It Forward Assistance Application
: 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 *
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.
at the end of the application to send it to us.
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.
Indicates required field
Home Phone Number (including Area Code)
Cell/Mobile Phone Number (including Area Code)
Work/Business Phone Number (including Area Code)
Re-enter Email Address
How would you prefer that we contact you? (Select one)
Are you currently a member of Scotties Rock Facebook group?
Are you currently a member of Scotties Rock Foundation Facebook group?
What is the name of the dog in need of assistance?
Please provide specific information about your situation and explain why you are requesting financial assistance for vet care for this dog.
Describe the type of vet care assistance you are requesting. (PLEASE NOTE: Your application will not be considered until we receive copies of written estimates for the cost of anticipated vet expenses, surgical procedures, medications, special food, etc. from you or your vet. Copies can be uploaded using the link below, emailed to ourscottiesrock@gmail, or sent to any SRF Board member by Facebook PM.
Upload Vet Cost Estimate. (Click the Browse button below to attach a document, PDF or photo that documents the vet cost estimate.)
Max file size: 20MB
Select the desired file
List the name of the veterinary clinic, veterinarian, and clinic telephone number of the veterinarian who has knowledge of your dog's condition and treatment needs.
How much funding are you requesting from Scotties Rock Foundation at this time? (PIF is considered a last resort safety net to provide help when all other possibilities have been exhausted. It is not a large fund nor is it intended to be a substitute for personal responsibility, pet insurance or other forms of public and private assistance.)
Please include the name and contact information of at least one other Scotties Rock member that has knowledge about your situation.
Do you have more than one source of income (example: income from a spouse, business income, etc.)?
If you have more than one source of income please explain:
What other sources of financial assistance have you applied for? (Click all that apply)
Banfield Foundation or other grant
Discounted vet care
What is the total amount of financial assistance you have received from these sources to date, if any?
Scotties Rock Foundation is based on the "Pay it Forward" philosophy; individuals who receive funding for vet care assistance from SRF are asked to, in turn, repay that kindness so that other future applicants may also receive help. If your application is approved, through which of these methods could you later “Pay it Forward”? (Click all that apply.)
Make a one-time donation to SRF when financially able to do so.
Set up a monthly recurring donation to SRF when financially able to do so.
Post a personal testimonial on SR and SRF Facebook pages describing how SRF assisted you and your furkid(s).
Participate in SRF auctions by donating items or bidding on items.
Create a birthday or anniversary fundraiser event benefiting SRF on Facebook.
Share the SRF auction information on my Facebook page so others can join in.
Use Amazon Smile when purchasing from Amazon with SRF as my designated charity.
Purchase SRF logo merchandise from Zazzle or the SRF website.
Conduct another type of personal fundraiser (examples: bake sale, garage sale, etc.) with proceeds benefiting SRF.
Please describe other "Pay-It-Forward" ideas you have:
I affirm that all the information contained on this application is true and correct.
I affirm that I have read the Pay it Forward Guidelines and that I have exhausted all other sources of financial means for vet care expenses and require assistance.
I agree that you may contact my veterinarian.
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.
Date of Application
How did you learn about the Scotties Rock Foundation's Pay-It-Forward Fund and program?
Please add any other comments or questions you may have here.
Click Here to Submit Your Application
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