Sam's Hope Pet Food Assistance Application
You MUST be a resident of Southeastern Pennsylvania and meet at least one of the following requirements to qualify for assistance.
     You qualify as low income, see chart below on website.
 You are unemployed.
 You are receiving government assistance.
 You are disabled and on a fixed income.
 You are a senior citizen on a fixed income.
 You are homeless.

The following information MUST accompany application:
     Recent proof of income, (check stub, tax return, W‐2, 1099).
 Proof of qualifying benefits, (Medicaid, Unemployment, Food Stamps, SSI).
 Proof of identification, (driver's license, or other photo identification with name and address).
 Completed pet food assistance application.

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Email *
Date *
Name *
Address *
City *
State *
Zip Code *
Phone *
Cell Phone *
How many cats do you own? *
How many cats are not spayed/neutered? *
How many dogs do you own? *
How many dogs are not spayed/neutered? *
Breed and weight of each dog? *
SIGNATURE - By signing this application, you attest that all information provided is true, complete and correct and that you have reviewed the eligibility requirements for pet food assistance and meet the qualification.  Your application is not complete until we receive evidence of financial hardship.   *
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