Request Pet Food Assistance

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Mission: At Halo's Heroes Foundation, our mission is to support families in need by providing dog food assistance to ensure that their pet dog remains with their loving family. We understand that pets are family, and we’re here to help keep them healthy and fed.

Eligibility: Assistance is available based on need and other criteria. Please fill out this form completely. All information will be kept confidential.

Email *

Full Name

Date of Birth *

YYYY

Address *

Phone Number *

Are you the primary caregiver for the pet? *

Yes. I live at the same address as the pet.

Yes. I live at a different address than the pet.

No. I live at the same address than the pet.

No. I live at a different address than the pet.

Other:

How many pets are you requesting pet food assistance for? *

Required

Type of Pet(s) that you are requesting assistance for:
Please list the name of your pet, species, breed, and birthday of each pet.
What's your pet's name?
Is it a dog, cat, bird, fish?
What breed is your pet?

What's your pet's birthday?

Are you currently receiving any of the following assistance programs? (Please check all that apply.) *

SNAP (Supplemental Nutrition Assistance Program)

WIC (Women, Infants, and Children)

TANF (Temporary Assistance for Needy Families)

Unemployment Benefits

Disability Benefits

Social Security Administration Benefits and/or Social Security Administration Retirement

Student receiving FAFSA Assistance and/or Federal Student Loans

Emancipated minor

None

Required

Total Household Income (Monthly): *

$0–$999

$1,000–$1,999

$2,000–$2,999

$3,000–$3,999

$4,000 or greater

Prefer not to answer

Required

Number of people living in the household: *

Any additional circumstances impacting your ability to provide food for your pet(s): *

Unemployment

Illness

Disability

Family Crisis

Natural Disaster

Other:

Required

Please tell us more about your regular feeding routine with your pet.
What type of food, brand, and amount of food do you usually provide for your pet?
*

Do you give permission for us to contact you by email, phone, and mail? *

Yes, I give permission for email, phone, and mail.

If you are selected and approved to receive pet food assistance from us, do you give permission for us to deliver it to your address? *

Yes

Certification:

I certify that the information provided is accurate and complete to the best of my knowledge. I understand that the pet food assistance that I am requesting is intended to support my pet(s) temporarily, and that I must meet need and other criteria in order to receive assistance. I understand that the information that I have provided may be used for reporting purposes related to grant funding and other funding sources.
By typing your full name below, you confirm that the information provided is accurate and you agree to the terms of the program.

Today's Date *

YYYY

Send me a copy of my responses.

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