Tripawds Gear Fund Application

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Three Legged Dog Assistive Device Donation Program
NOTE: Application deadline is the 1st and 15th of each month. You may apply a maximum of two times. Please read complete details before applying at http://tri.pet/gearfund

Email *

First Time Applying? *

Yes, This is my first application.

I have applied once before.

Original Application Date:

(Or Today's Date)

YYYY

Applicant (Full Name) *

NOTE: Name must match supporting documentation submitted

Shipping: Delivery Address *

Provide complete street address, U.S. only, no P.O. boxes.

Shipping: City, State & Zip Code *

Telephone *

Email Address *

Tripawds Username *

Tripawds community participation is encouraged to get and share the best amputation recovery and care tips. Register at http://tripawds.com/start/

Dog's Name *

ITEM SELECTION (Harness OR Sling)

Select desired product and indicate size.

Preferred Assistive Device *

Please select desired item here. (Enter applicable size below.)

Ruffwear Flagline Harness

GingerLead Dog Sling

Flagline Sizing: Girth Measurement

Ruffwear Harness Size

Only applicable if Flagline harness is selected above. Refer to sizing chart below. Take the girth measurement carefully while your dog is standing up. Please measure carefully, there are no returns or exchanges.

L/XL

MED

XXS

Clear selection

Preferred Color (Flagline Harness Only)

NOTE: Color may be substituted based on availability.

Red Rock

Granite Grey

Meltwater Teal

Clear selection

GingerLead Dog Sling Size:

Only applicable if GingerLead dog sling is selected above. Refer to sizing chart below. Please measure carefully, there are no returns or exchanges.

Tall Female

Tall Male

Large Female

Larg Male

Medium (Male or Female)

Small Female

Small Male

Small Mini

Clear selection

INCOME REPORTING

NOTE: Annual gross household income disclosure required in addition to Need Qualification documentation.

Household Income *

Total annual income of all people in household.

Number of People in Household *

Need Qualification *

How will you provide proof of qualification?

Entitlement Program Enrollment Proof

Documented Income

QUALIFICATION NOTES:

1. Email proof of enrollment in state or federal entitlement program, including: WIC, welfare, food stamps, Medicaid, VA Disability Compensation, Social Security Disability or Supplemental Security Income.
OR
2. Email proof of current annual household income at or below 200% of federal or state poverty guidelines. See Table 1 below for details. Proof of income can be provided in the form of: a) current pay stub(s) indicating at least six months of income, or b) your most recent income tax forms. All documentation must show the same name(s) as indicated on the vet clinic receipt for amputation surgery.

NOTE: We do not need your social security number. Please omit from all documents.

PLEASE REFER TO CURRENT FEDERAL POVERTY GUIDELINES FOR GROSS ANNUAL INCOME BELOW. 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA. FOR FEDERAL POVERTY GUIDELINES IN ALASKA AND HAWAII, PLEASE VISIT https://aspe.hhs.gov/poverty-guidelines

APPLICATION CHECKLIST

I AGREE to provide a photo of my dog wearing the harness along and brief article for publication by Tripawds if selected as a grant recipient.

INCLUDE: Copy of photo ID

INCLUDE: Financial Need Documentation...

1. Proof of entitlement program enrollment (award letter or payment stub), OR:

2. Proof of income (Paycheck stubs indicating at least 6 months of income or most recent Tax forms)

EMAIL ALL SUPPORTING DOCUMENTATION IN ONE EMAIL TO FOUNDATION@TRIPAWDS.ORG WITH THE SUBJECT "GEAR FUND APPLICATION"

Qualifying Household Income

Send me a copy of my responses.

Submit

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