Application – Starfleet Canine Aid Foundation

Financial Aid Application

I have read all of the SCAF eligibility criteria and certify that this application complies with all criteria. All applications must be accompanied by the required documentation in order to be processed. Refer to "Responsibilities of Applicants in the SCAF Guidelines. ***Only CA Residents may apply for Grants at this time"

If this is not your first application to SCAF, when did you last apply?
Date*
MM slash DD slash YYYY
Applicant Name*
Address*
Street Address City State ZIP Code

CA Residents only
Phone*
Alternate Phone
Email*
What is the name of your dog?*
What is the breed of your dog?*
How old is your dog?*
Please explain the history of your dog's current medical problem.*
Please explain what diagnostic tests and treatment have been started for your dog so far for this problem.*
What is the medical diagnosis that has been made by the Veterinarian for your dog?*
Please explain what medical treatment is being recommended for your dog.*
What is the medical prognosis for your dog, made by a Veterinarian?*
Does your dog have any other known medical problems related to this diagnosis or not?*
What is the cost of treatment quoted on the estimate from your Veterinarian (excluding diagnostics).*
If aid is awarded, SCAF will contribute a maximum of $500. How will you pay the balance above the $500?*
How did you hear about SCAF?
To confirm your submission, please wait for 'Thank You' reply after submitting, before logging off of website.

Financial Aid Application

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