Wags4Patriots Application form

Wags4Patriots Application Form
Grant Guidelines:
- Only Military Veterans with a PTSD diagnosis are considered for the Wags4Patriots grant.
- Funding may be used only to help offset the adoption costs for obtaining a PTSD service dog. Funding is paid directly to the service dog agency.
- Funding is contingent upon the individual successfully completing the service dog agency’s application to qualify for a PTSD service dog.
- Only applications received through the appropriate online submission process will be eligible.
- Funding is awarded on a case-by-case basis.
Before submitting an application, applicants must ensure that it includes all of the following documents or their request will be considered incomplete and may be discarded:
- Completed and signed grant application
- Photograph(s) of applicant
- Signed media release
The following additional documents will also be required prior to the award of any grant:
- Copy of 501(c)(3) letter from the applicable credentialed service dog agency if not one we have worked with
- Photograph(s) of service dog
Application
Name
E-mail
Phone Number

- Area Code Phone Number

Your Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Birth Date

Month Day Year
Age
Sex:

Male Female
Dog Name
Dog Breed
Dog Age Upon Match with Veteran:
Dog Sex:

Male Female
Date you received/will receive your PTS service dog (must be within three months of application date):

- Month - Day Year
Please describe your needs
If you have not yet received your service dog, please describe why you want/need a PTSD service dog and how you think a dog will assist you. If you have received your service dog, how has your service dog helped you? *
PTSD Service Dog Agency
Name of agency where I will adopt my PTSD Service Dog

Service Dog Agency address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Name of Contact Person at service dog agency *
Phone Number

- Area Code Phone Number
Their e-mail address
Required Documents
IMPORTANT: Supporting documentation below must be attached to this application
Photograph(s) of applicant *
Upload signed media release form: *
Download media release form here.
The following additional documents will also be required prior to the award of any grant:
Photograph(s) of service dog
Disclosure & Agreement
By signing below, I agree that I have submitted this application in good faith and my submission fits the eligibility requirements set for this grant. Further, I indicate that I understand and agree to abide by the rules, guidelines and requirements of the grant. I also indicate by signing below that I understand incomplete applications and/or the submission of false information may result in my application being denied. Further, I understand that I may be barred from future funding opportunities made available by American Humane Association should I falsify any information on my application. Additionally, my signature indicates that I understand funding is limited and therefore only select applicants will receive grant funding. Finally, by signing below, I indicate that I understand American Humane Association will use selected cases/grant awards for fundraising purposes and that I give the organization, and its employee, officers, directors or representatives the authority to do so.
Sign with full name

First Name Last Name
Disclosure and Agreement Signature: *

Clear
NOTE: Our Applicant Review Committee will screen your complete applicant packet to determine that you meet our applicant requirements. It is not possible to advise how long you may wait for a grant award for a service dog. Grant awards are based on availability of funds that can be procured by American Humane Association.
AMERICAN HUMANE ASSOCIATION IS A 501(C)(3) NON-PROFIT ORGANIZATION. CONTRIBUTIONS TO AMERICAN HUMANE ARE TAX-DEDUCTIBLE TO THE EXTENT PERMITTED BY APPLICABLE LAW.
Should be Empty:

Wags4Patriots Application Form

Grant Guidelines:

Application

Please describe your needs

PTSD Service Dog Agency

Required Documents

Disclosure & Agreement