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The Mouse Fund Application and Requirements

Medical Costs Can Add Up Quickly

We know that emergencies happen. That is why we offer financial assistance to qualifying pet parents to help with medical costs.

Below the application, you will find a range of other resources that we hope will be helpful.

Application Requirements

Please note: Your annual income must be under $24,000 for an individual household and under $42,000 for a family.

If you do not meet this requirement, the resources below the application may prove helpful.

The Mouse Fund Application

I. Pet Owner Information

Applicant's Full Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Phone Number(Required)

How did you hear about the Mouse Fund?

If "Other," please specify

II. Pet Information

Pet's Name(Required)

Species

If "Other," please specify the species

Breed

Age — Years

Age — Months

Gender

Male

Female

Unknown

Is your pet spayed/neutered?

Yes

No

Unknown

III. Veterinary Information

Veterinarian's Name(Required)

First Last

Veterinary Clinic Name(Required)

Veterinary Clinic Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Person at the Clinic (for billing/information)

Veterinary Clinic Phone Number(Required)

Veterinary Clinic Email Address

IV. Medical Condition and Treatment

What is the primary medical condition for which you are seeking assistance?(Required)

When did you first notice the symptoms?

Date of diagnosis

What is the official diagnosis?

Please describe the recommended treatment plan and its estimated cost(Required)

Has your pet already received any treatment for this condition?

Yes

No

If "Yes," please describe the treatment and the cost incurred so far

Please upload a copy of the detailed treatment plan and cost estimate from your veterinarian.(Required)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

Please upload any relevant medical records or diagnostic reports.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

V. Financial Information

What is your current employment status?

Approximate total monthly household income (before taxes)

Please list any other sources of income

Please attach a copy of your most recent federal tax return filed with the IRS — not a pay stub or W-2.

If you do not file a Federal Tax Return, please provide a copy of government assistance documentation, such as disability income, a food stamp letter, or medical aid care.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

Do you have pet insurance?

Yes

No

If "Yes," please provide the insurance company name and policy number

Have you filed a claim with your pet insurance for this condition?

Yes

No

If "Yes," what was the outcome (approved amount, denied, pending)?

Have you applied for or received assistance from other animal welfare organizations for this pet's medical care?

Yes

No

If "Yes," please list the organization(s) and the amount of assistance received or pending

Do you qualify for CareCredit or Scratchpay?

Yes

No

If no, please attach a copy of your letter stating you were not approved.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

Have you applied to at least 3 other charities?

Yes

No

If yes, which ones?

Have you started crowdfunding via GoFundMe or Waggle?

Yes

No

If yes, please provide the link to the site

How much are you able to contribute towards your pet's medical expenses at this time?

Please briefly explain your current financial situation and why you need assistance.(Required)

VI. Agreement and Authorization

I certify that the information provided in this application is true and accurate to the best of my knowledge.(Required)

I certify that the information provided in this application is true and accurate to the best of my knowledge.

I understand that the Mouse Fund has limited resources and that applying does not guarantee financial assistance.(Required)

I understand that the Mouse Fund has limited resources and that applying does not guarantee financial assistance.

I authorize the Mouse Fund to contact my veterinarian to verify the information provided and discuss my pet's medical condition and treatment plan.(Required)

I authorize the Mouse Fund to contact my veterinarian to verify the information provided and discuss my pet's medical condition and treatment plan.

I understand that if funding is approved, the payment will be made directly to the veterinary clinic/pharmacy.(Required)

I understand that if funding is approved, the payment will be made directly to the veterinary clinic/pharmacy.

I agree to notify the Mouse Fund of any changes in my pet's medical or financial conditions.(Required)

I agree to notify the Mouse Fund of any changes in my pet's medical or financial conditions.

VII. Submission

Applicant's Full Name (typed)(Required)

First Last

Date of Application(Required)

Additional Resources

Veterinary Financing Options (often at the point of care)

Cherry — payment plans for veterinary care.
CareCredit — a credit card specifically for healthcare expenses, including veterinary care.
iCare Financial — various financing options for veterinary services.
Wells Fargo Health Advantage (now Synchrony Health) — credit lines for healthcare, including veterinary care.
LendingUSA — personal loans that can be used for pet care.

Assistance for Service Dogs

U.S. Department of Veterans Affairs — benefits for veterans with service dogs.

Veterinarian Offices and Networks with Potential Financial Assistance

Your veterinary office may offer in-house financing through a sliding scale, payment plan, or practice fund. If not, here is a network of veterinary offices that do:

AllCare Veterinary Network — a group of veterinary hospitals.

Crowdfunding

Waggle — a crowdfunding platform specifically for pet medical expenses.
GoFundMe: Help with Vet Bills
Dogster: Crowdfunding for Vet Bills

Don’t forget to use social media to help gain support for your campaign.

Other Charities

Diabetes

Diabetic Cats in Need — One-Time Assistance Program

Cats

Merrimack River Feline Rescue Society — Veterinary Funding Assistance

Cats and Dogs

For the Love of Alex
Friends and Vets Helping Pets
Paws 4 A Cure
Frankie’s Friends
Onyx and Breezy Foundation
RedRover
The Peanut Fund
Pet Assistance Inc.

Homeless Pets

Trio Animal Foundation

Amputation

Tripawds

Dogs Only

Live Like Roo Foundation
Bow Wow Buddies Foundation
Brown Dog Foundation
Lexi’s Legacy
HEAL Foundation — Grants for Pet Owners
Miranda’s People — Financial Assistance
The Mosby Foundation — Apply for Aid

I. Pet Owner Information

Applicant's Full Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Phone Number(Required)

How did you hear about the Mouse Fund?

If "Other," please specify

II. Pet Information

Pet's Name(Required)

Species

If "Other," please specify the species

Breed

Age — Years

Age — Months

Gender

Male

Female

Unknown

Is your pet spayed/neutered?

Yes

No

Unknown

III. Veterinary Information

Veterinarian's Name(Required)

First Last

Veterinary Clinic Name(Required)

Veterinary Clinic Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Person at the Clinic (for billing/information)

Veterinary Clinic Phone Number(Required)

Veterinary Clinic Email Address

IV. Medical Condition and Treatment

What is the primary medical condition for which you are seeking assistance?(Required)

When did you first notice the symptoms?

Date of diagnosis

What is the official diagnosis?

Please describe the recommended treatment plan and its estimated cost(Required)

Has your pet already received any treatment for this condition?

Yes

No

If "Yes," please describe the treatment and the cost incurred so far

Please upload a copy of the detailed treatment plan and cost estimate from your veterinarian.(Required)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

Please upload any relevant medical records or diagnostic reports.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

V. Financial Information

What is your current employment status?

Approximate total monthly household income (before taxes)

Please list any other sources of income

Please attach a copy of your most recent federal tax return filed with the IRS — not a pay stub or W-2.

If you do not file a Federal Tax Return, please provide a copy of government assistance documentation, such as disability income, a food stamp letter, or medical aid care.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

Do you have pet insurance?

Yes

No

If "Yes," please provide the insurance company name and policy number

Have you filed a claim with your pet insurance for this condition?

Yes

No

If "Yes," what was the outcome (approved amount, denied, pending)?

Have you applied for or received assistance from other animal welfare organizations for this pet's medical care?

Yes

No

If "Yes," please list the organization(s) and the amount of assistance received or pending

Do you qualify for CareCredit or Scratchpay?

Yes

No

If no, please attach a copy of your letter stating you were not approved.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 256 MB, Max. files: 10.

Have you applied to at least 3 other charities?

Yes

No

If yes, which ones?

Have you started crowdfunding via GoFundMe or Waggle?

Yes

No

If yes, please provide the link to the site

How much are you able to contribute towards your pet's medical expenses at this time?

Please briefly explain your current financial situation and why you need assistance.(Required)

VI. Agreement and Authorization

I certify that the information provided in this application is true and accurate to the best of my knowledge.(Required)

I certify that the information provided in this application is true and accurate to the best of my knowledge.

I understand that the Mouse Fund has limited resources and that applying does not guarantee financial assistance.(Required)

I understand that the Mouse Fund has limited resources and that applying does not guarantee financial assistance.

I authorize the Mouse Fund to contact my veterinarian to verify the information provided and discuss my pet's medical condition and treatment plan.(Required)

I authorize the Mouse Fund to contact my veterinarian to verify the information provided and discuss my pet's medical condition and treatment plan.

I understand that if funding is approved, the payment will be made directly to the veterinary clinic/pharmacy.(Required)

I understand that if funding is approved, the payment will be made directly to the veterinary clinic/pharmacy.

I agree to notify the Mouse Fund of any changes in my pet's medical or financial conditions.(Required)

I agree to notify the Mouse Fund of any changes in my pet's medical or financial conditions.

VII. Submission

Applicant's Full Name (typed)(Required)

First Last

Date of Application(Required)

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Contact Us
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