Application – Bandits K9Care

Medical Fund Application

Bandit’s Medical Fund Application Process & Guidelines

Please fill out the medical fund application completely and with as much detail as possible. This is your opportunity to make the case for why our organization should provide assistance to your dog. We generally respond via email within a few days of receiving completed applications.

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Name of Applicant

First

Last

Applicant's Address

Address Line 1

City

State

Zip Code

Layout

Phone

Link to Applicant's Facebook Profile

(Copy and paste link from top of your Facebook profile - put N/A if not on Facebook)

Dog's Name

Layout

Dog's Breed

Dog's Age

Name of Veterinary Hospital you will be working with for this medical problem.

( May be different from your primary veterinarian)

Veterinarian's Address

Address Line 1

City

State

Zip Code

Veterinarian's Phone

Why are you applying for assistance? Include as much information as possible about your dog's medical problem(s) and diagnosis.

What is an estimate of the cost you are requesting help with and how much has been spent on veterinary care so far on this issue?

Why do you need financial assistance and why you believe you qualify for funding under the guidelines of this program?

Do you agree to provide bank statements, SSI award letters, tax returns, and other financial documentation to support your application plus photos of your dog?

How did you learn about Bandit's K9Care?