Tripawds Gear Fund Application
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
First Time Applying?
Yes, This is my first application.
I have applied once before.
Original Application Date:
(Or Today's Date)
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
Tripawds community participation is encouraged to get and share the best amputation recovery and care tips. Register at
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.
Preferred Color (Flagline Harness Only)
NOTE: Color may be substituted based on availability.
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.
Medium (Male or Female)
NOTE: Annual gross household income disclosure required in addition to Need Qualification documentation.
Total annual income of all people in household.
Number of People in Household
How will you provide proof of qualification?
Entitlement Program Enrollment Proof
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.
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
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
WITH THE SUBJECT "GEAR FUND APPLICATION"
Qualifying Household Income
Send me a copy of my responses.
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