Please note:
Please send fees and proof of income to the campus you intend on visiting for the SNAP program.
The Milwaukee Campus no longer accepts applications to the SNAP program. Please check out our new Spay/Neuter Clinic in West Allis .
If you are applying to the Ozaukee Campus , please send documentation and payment to:
SNAP Application Wisconsin Humane Society: Ozaukee Campus 630 West Dekora St. Saukville, WI 53080
* 1.
Question - Required -
Please select the campus you are applying to:
Ozaukee Campus
2.
General Information:
*
Name:
*
Email: Required
*
Street 1: Required
Street 2:
*
City/State/ZIP:
*
Phone Number: Required
* 3.
Question - Required -
How did you hear about the Wisconsin Humane Society Spay/Neuter Assistance Program?
Please make at least 1 selection from the choices below.
4.
Question - Not Required -
If other, where?
* 5.
Question - Required -
Number of adults in your household?
* 6.
Question - Required -
Number of children in your household?
* 7.
Question - Required -
Number of cats in your household?
* 8.
Question - Required -
Number of dogs in your household?
* 9.
Question - Required -
Number of animals spayed/neutered in your household?
Household Income Verification
10.
Question - Not Required -
Please check all that apply to your household. You will need to bring proof of qualification to your initial exam appointment.
OR
11.
Question - Not Required -
If none of the above apply, you may qualify based on household income. Households with income at 70% or less of level qualify for SNAP services. Please check types of income and total monthly household income below. You will need to bring proof of qualification to your initial exam appointment.
12.
Question - Not Required -
Total annual gross household income of all adults in household:
Please remember to
mail a $10 non-refundable fee for each animal to the appropriate campus.
Animal Information
Animal 1
* 13.
Question - Required -
Type:
Please select response
Dog
Cat
* 14.
Question - Required -
Sex:
Please select response
Male
Female
* 15.
Question - Required -
Spayed/Neutered:
Please select response
Yes
No
* 16.
Question - Required -
Pregnant:
Please select response
Yes
No
* 17.
Question - Required -
Name:
* 18.
Question - Required -
Age:
* 19.
Question - Required -
Breed:
* 20.
Question - Required -
Color/Markings:
Animal 2
21.
Question - Not Required -
Type:
Please select response
Dog
Cat
22.
Question - Not Required -
Sex:
Please select response
Male
Female
23.
Question - Not Required -
Spayed/Neutered:
Please select response
Yes
No
24.
Question - Not Required -
Pregnant:
Please select response
Yes
No
25.
Question - Not Required -
Name:
26.
Question - Not Required -
Age:
27.
Question - Not Required -
Breed:
28.
Question - Not Required -
Color/Markings:
Animal 3
29.
Question - Not Required -
Type:
Please select response
Dog
Cat
30.
Question - Not Required -
Sex:
Please select response
Male
Female
31.
Question - Not Required -
Spayed/Neutered:
Please select response
Yes
No
32.
Question - Not Required -
Pregnant:
Please select response
Yes
No
33.
Question - Not Required -
Name:
34.
Question - Not Required -
Age:
35.
Question - Not Required -
Breed:
36.
Question - Not Required -
Color/Markings:
37.
Question - Not Required -
If you have additional concerns about your pet's health, please describe below. Please remember that this program only offers spay/neuter surgeries and initial preventative care at the time of surgery.
(Maximum response 255 chars, approx. 5 rows of text)
After
we review your application, we will contact you to confirm that you qualify for
the program and to set an appointment.
Please bring any medical records you
have for your animal(s) to the first scheduled appointment for your animal.
* 38.
Question - Required -
I understand that I will be denied services if I do not qualify financially based on SNAP program guidelines, if I falsify any information on this application or if I do not provide documentation verifying that I qualify. I certify that I have reviewed the information on this application, that it is true to the best of my knowledge and that I am required to demonstrate financial need to receive any services. I also understand that I will only be permitted one cancelled or rescheduled appointment. If I cancel or miss a second appointment, it may be at least 6 months before the Wisconsin
Please select response
Yes
No