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 http://tri.pet/gearfund
Email address *
First Time Applying? *
Original Application Date:
(If Applicable)
MM
/
DD
/
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 Harness Size
Only applicable if Web master 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.
Clear selection
Preferred Color (Ruffwear Harness Only)
NOTE: Color may be substituted based on availability.
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.
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?
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
Qualifying Household Income
Submit
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