VAP Emergency Fund application

(Please Print Clearly)
APPLICANT INFORMATION (Pet Owner must complete)
First Name: / Last Name:
Street Address:
City: / State: / Zip Code:
Home Phone #: / Alternate Phone #:
Email Address:
Qualifications (check all that applies)
I am over 65 and on financial assistance. List the type of assistance you are receiving:
I am over 55, disabled and on financial assistance. List the type of assistance you are receiving:
I am a United States Military Veteran
PET INFORMATION (Veterinarian must complete)
Pet’s Name: /  Cat  Dog
Breed: / Mixed Breed?  Yes  No
Age: / Color: / Weight: / Gender:  Male  Female 
Date when was diagnosis made:
Diagnosis:
Veterinarian name and location:
What will happen if pet is not treated?
Has this animal received vaccinations?  Yes  No / Date Last vaccinated:
Has this animal been spayed or neutered?  Yes  No

Acknowledgement (Pet Owner and veterinarian must sign)

I hereby certify that the information provided in this application is true and correct to the best of my knowledge. If approved, funds will be paid directly to the Veterinarian.
Applicant’s signature: / Date:
Veterinarian’s signature: / Date:
For Internal Use Only

Approved or Denied______Reason for Denial: ______

Date Check Issued: ______Check #: ______Amount: ______

Check Issued to:______

Below are general guidelines and the process to submit an application for emergency funds. Every request will be reviewed on a case by case basis. Assistance is limited to $150 per application and $300 annual per owner. VAP's Emergency Fund reserves the right to either grant or deny a funding assistance request without further explanation. In addition, final funding decisions will be based on resources available.Payment will be paid directly to the veterinarian.

Qualifications:

1)The owner must be over 65 and on financial assistance or

2)The owner must be disabled and over 55 and on financial assistance or

3)The owner is a United States Military Veteran

4)The owner has exhausted their own resources

5)The cat or dog must have a treatable condition that requires medication

6)The veterinarian's prognosis (in the veterinarian's best professional judgment) indicates that euthanizing the cat or dog is required to avoid further suffering.

7)The ownerconsents to allow Valley Animal Partners to use any pictures and descriptions of medical care for the purposes of promotion and fund raising.

The following will not be funded:

1)Medical care for pets with a poor prognosis or already deceased.

2)Medical bills already covered by other resources.

3)Cancer diagnosis or treatments.

4)Spay/Neuter or routine medical care or vaccinations.

5)Dental Care.

6)Maintenance medicines.

To request assistance:

1)The pet owner must complete the ‘Applicant Information’ section of the application.

2)The pet owner must sign the ‘Acknowledgement’ section of the application.

3)The veterinarian must complete the ‘Pet Information’ section of the application.

4)The veterinarian must sign the ‘Acknowledgement’ section of the application.

5)The veterinarian can submit the application to Valley Animal Partners (VAP):

  1. Mail application to: VAP Emergency Fund for Snoqualmie Valley Cats and Dogs PO Box 2586,North Bend, WA 98045
  2. Email application to:
  3. Who to contact if you have need an immediate response:
  4. Andrea Logan: 425-466-4621 or
  5. Carolyn Loew: 425-295-1262 or