This Letter Contains Important Information. Please read it. Dear SNAP Applicant, Please complete the enclosed application for Second Chance Animal Center’s Spay/Neuter Assistance Program. You will need one application for each cat/dog that needs to be spayed/neutered. Mail the completed application to: Second Chance Animal Center – Attn: SNAP PO Box 620 Shaftsbury, VT 05262 (Make sure to mark your envelope Attn: SNAP to avoid delays in processing your application.) Cat Owners ‐ All cats are spayed/neutered at the shelter’s SNAP clinics that are held each week. You will be contacted within two weeks of your application being processed. We will ask about your cat’s vaccine history, discuss your co‐ payment amount and set a surgery date for your cat. Approximately one week prior to your cat’s surgery date, you will receive an email confirming the surgery date and giving you detailed drop off and pick up instructions, as well as feeding instructions for the night before the surgery. Dog Owners ‐ For dogs that will be spayed/neutered through the SNAP program you will receive a letter in the mail stating you are approved and your co‐payment amount. Dogs are spayed/neutered at local veterinarians who accept the SNAP certificate. If your dog needs a rabies vaccine, there is an additional $16 charge. Co‐payments are to be mailed to the address above. Once SCAC receives your check or money order for your co‐payment amount, a SNAP certificate will be mailed to you along with a list of veterinarians that accept the certificate. Please be advised that some of the veterinarians charge additional fees. It is your responsibility to check with the veterinarian you choose and find out if there are fees that are not covered by the SNAP certificate. If so, those fees are your responsibility to pay. If you have any questions about the SNAP Program, you can reach us by email at [email protected] **If you are a dog owner who is a resident of Vermont and receives public assistance, such as food stamps, fuel assistance, SSI disability, etc., there is a state funded program which you may qualify for called VSNIP. The co‐payment for this program is $25. If you feel you qualify and prefer to use the VSNIP program, please call the VSNIP office at 855‐478‐7647 for an application. VSNIP is NOT a Second Chance Animal Center program.** Thank you for being a responsible pet owner and having your pet spayed or neutered. SPAY/NEUTER ASSISTANCE PROGRAM (SNAP) PET OWNER APPLICATION FORM* To apply for SNAP, please complete this application form and submit it to: Second Chance Animal Center ATTN: SNAP P.O. Box 620 Shaftsbury, VT. 05262 INFORMATION ABOUT YOU . PRINT CLEARLY AND LEGIBILY. BE SURE TO INCLUDE YOUR EMAIL ADDRESS. **SURGERY CONFIRMATIONS WILL BE EMAILED TO YOU.** Name: Home Phone: ( Address: ) Email: (Street) Who is your veterinarian? ______________________________________ (City, State, Zip) Mailing Address (if different) Do you have other pets? How did you hear about SNAP? ______________________________________ Y Are they spayed/neutered? Number of N Y If not, do you need assistance from SNAP? N INFORMATION ABOUT YOUR PET: Cat or Dog Cats Y N How did you obtain this pet? Male or Female Age: Name: If this pet is a female, has she had any litters? How long have you owned this pet? Y N If so, how many? INFORMATION ABOUT YOUR NEED FOR ASSISTANCE: No. of household members: Total monthly income & benefits (of ALL household members) Do you Dogs Own Rent Rent/Mortgage $ Do you participate in any of the following public assistance programs? (Check all that apply) Dr. Dynasaur Fuel Assistance Food Stamps Medicaid/Medicare Reach-Up Section 8 Social Security (main income) SSI WIC Lifeline-telephone PATH VHAP AFDC or TAFDC Unemployment Benefits $ Please give us any other information that would help clarify your need for financial assistance I understand that the SNAP Program is for low income pet owners only or people who are having financial difficulties right now. I certify that the information on this application is accurate. Signature Date *You may apply for your pet or strays/ferals that you are currently caring for. If you have more than one pet to be spayed or neutered, you must complete an application for each animal. You will be notified of your eligibility for the Spay/Neuter Assistance Program by phone within two weeks of the shelter receiving the completed application. If you need help completing the application please call the SNAP Coordinator at 802-375-2898 x 312 or fax the completed application to 802-375-0235.