FOOD ASSISTANCE PROGRAM
Welcome to Companion Pets of Cleveland Food Assistance program.
Your membership allows a monthly pickup of dry and or wet food for your pet(s) for one year. Because we are donation-based, we cannot promise specific food types or name brands.
If food availability becomes an issue, you will be given a Resource guide that lists many services available in the Northeast Ohio area.
When you need more food please use our Food Assistance Reorder form via the Companion Pets of Cleveland website. We will contact you once the form is received to schedule an appointment to pick up food. This allows us to make sure we have what you need. Bring your membership card at the time of each visit.
The application you will fill out has many questions regarding you and your pets. There are no judgments, and the statistical information provided from your answers will be used in the future to secure grant funding.
We believe in this program and would like to see it continue!
Bob Stevens
Founder, Executive Director
Carol Rini
Food Assistance Program Chair
* Required
NAME (Legal Owner)
*
Your answer
STREET # and NAME
*
Your answer
CITY, STATE & ZIP
*
Your answer
PHONE: HOME or CELL
*
Your answer
CAN WE TEXT THIS NUMBER
*
YES
NO
EMAIL ADDRESS
*
Your answer
GOVERNMENT ASSISTANCE (SELECT ALL THAT APPLIES)
*
SECTION 8 or PUBLIC HOUSING
MEDICAID
MEDICARE
VETERAN BENEFITS LETTER
SSI or SSDI (DISABILITY)
UNEMPLOYMENT COMPENSATION
OHIO WORKS FIRST
WIC
OHIO DIRECTIONS CARD (FOOD STAMPS)
SOCIAL SECURITY (RETIREMENT)
GROSS HOUSEHOLD INCOME less than 150% of the Federal Poverty Level
Required
ARE YOU A MILITARY VETERAN?
*
YES
NO
HOW DO YOU IDENTIFY?
*
MALE
FEMALE
NON BINARY
AGE RANGE
*
18-25
26-54
OVER 55
NAME OF PET #1
*
Your answer
SPECIES OF PET #1:
*
CAT
DOG
Required
GENDER of PET #1:
*
Male
Female
Required
APPROX. WEIGHT OF PET #1:
*
Your answer
IS PET #1 THE SIZE OF:
*
Small: Yorkie, Maltese or a Shih Tzu
Medium: Boxer, Labrador Retriever, PitBull
Large: Great Dane, Rottweiler, Bullmastiff
IS PET #1:
*
SPAYED
NEUTERED
NO, but might be interested in help with having it done.
Required
APPROX. AGE OF PET #1:
*
Your answer
DOES PET #1 NEED VACCINATIONS?
*
YES
NO - WOULD BE INTERESTED IN GETTING THEM
IS PET #1 MICROCHIPPED?
*
YES
NO - WOULD BE INTERESTED
NAME of PET # 2:
Your answer
SPECIES of PET #2:
CAT
DOG
GENDER of Pet #2:
MALE
FEMALE
APPROX. WEIGHT of PET #2:
Your answer
IS PET #2 THE SIZE OF:
Small: Yorkie, Maltese or a Shih Tzu
Medium: Boxer, Labrador Retriever, PitBull
Large: Great Dane, Rottweiler, Bullmastiff
Clear selection
IS PET #2:
Spayed
Neutered
NO, but might be interested in help with having it done.
APPROX. Age of Pet #2
Your answer
DOES PET #2 NEED VACCINATIONS?
YES
NO - WOULD BE INTERESTED IN GETTING THEM
Clear selection
IS PET #2 MICROCHIPPED?
YES
NO - WOULD BE INTERESTED
Clear selection
NAME of PET #3
Your answer
SPECIES of PET #3:
CAT
DOG
GENDER of Pet #3:
MALE
FEMALE
APPROX. WEIGHT of Pet #3:
Your answer
IS PET #3 THE SIZE OF:
Small: Yorkie, Maltese or a Shih Tzu
Medium: Boxer, Labrador Retriever, PitBull
Large: Great Dane, Rottweiler, Bullmastiff
Clear selection
Is Pet #3:
SPAYED
NEUTERED
NO, but might be interested in help with having it done.
BREED of Pet #3:
Your answer
APPROX. Age of Pet #3:
Your answer
DOES PET #3 NEED VACCINATIONS?
YES
NO - WOULD BE INTERESTED IN GETTING THEM
Clear selection
IS PET #3 MICROCHIPPED?
YES
NO - WOULD BE INTERESTED
Clear selection
ADDITIONAL PET's (Please include name, species, weight, age, spay/neutered status, breed)
Your answer
WHAT DO YOU NEED? (Select All That Apply)
*
Cat Food
Kitten Food
Does your cat/kitten eat canned food?
Dog Food
Puppy Food
Does you Dog/Puppy eat canned food?
Litter (if available)
Required
"OTHER" INFORMATION (Does your animal have special needs, diet, etc.?) Use N/A if none.
*
Your answer
VETERINARIANS NAME & PHONE NUMBER:
Your answer
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