Spay/Neuter Voucher Application

Spay/Neuter Voucher Application
Primary Contact Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
What is the best way to contact you?*

By phoneBy email
Are you 18 years of age or older?*

YesNo
Have you received a spay/neuter voucher from FCARL before?*

YesNo
When did you receive a voucher?
How did you hear about the FCARL voucher program?*

Local ShelterVeterinarianInternetOther
Please provide more information on how you heard about us.
Your Employment Status*

Full TimePart TimeUnemployedStudentRetiredLaid OffOther
Please provide more information on your selection of "Other"
Spouse / Partner / Roommate Employment Status*

No Spouse / Partner / RoommateFull TimePart TimeUnemployedStudentRetiredLaid Off
What is your total annual household income?*

Less than $10,000$10,001 - $25,000$25,001 - $40,000$40,001 - $60,000More than $60,000
Financial Information

If you cannot provide a copy of your latest income tax return then you must provide via upload ONE of the following:
- A copy of your last 3 check stubs
- W-2 or 1099 from employer
- SSI/SSDI/SSA benefits letter
- Unemployment benefits letter
- Food stamps or Medicaid eligibility letter
Please upload your latest income Tax Return or financial information*

Accepted file types include - pdf, doc, docx, jpg, jpeg, png, gif / Maximum File size 10mb
Cancelof
Please upload a copy of a utility bill dated within the last three months. Your name and address must be listed on the utility bill.*

Accepted file types include - pdf, doc, docx, jpg, jpeg, png, gif / Maximum File size 10mb
Cancelof
Photo Identification

A valid, Floyd County ID is also required to receive a voucher from FCARL, in addition to ONE of the financial documents listed above.

Please Note: The name and address on your application must match the name and address on your ID.
Please upload a copy of your Photo ID *

Accepted file types include - pdf, doc, docx, jpg, jpeg, png, gif / Maximum File size 10mb
Cancelof
About Your Voucher Needs
Describe the circumstances that are keeping you from being able to afford to cover the full cost of getting your animal(s) spayed/neutered: *
FCARL provides spay/neuter vouchers that covers up to $100 toward the cost of getting your animal(s) fixed. You are responsible for any other costs over and above $100*

I agree
Are any of your animals being used for breeding purposes? Are they producing puppies or kittens?*

YesNo
About Your Animal
Animal Name*
Animal Age*
Animal Gender*

FemaleMale
Pet Species*

CatDogRabbitOther
Please provide more information on the species of your pet.
When did this animal join your household? *

MonthDayYear
Date
Where did the animal(s) you are requesting a voucher come from?*

Rescue OrganizationAnimal ShelterOnline AdBreederFoundOther
Please provide more information on your answer of "Other"
Name of Rescue Organization
Name of Animal Shelter
Website of Online Advertisement
Name of Breeder
Where and when did you find this animal?
Do you have a current veterinarian?*

YesNo
Please provide the veterinary clinic name below
Have you scheduled an appointment to have your animal altered?*

YesNo
Would you like assistance with a referral to local veterinarians?
Would you like to add an additional animal for vouchers?*

YesNo
About Your 2nd Animal
Animal #2 Name
Animal Age
Animal Gender

FemaleMale
Pet Species

CatDogRabbitOther
Please provide more information on the species of your pet.
When did this animal join your household?

MonthDayYear
Date
Where did the animal(s) you are requesting a voucher come from?

Rescue OrganizationAnimal ShelterOnline AdBreederFoundOther
Please provide more information on your answer of "other"
Name of Rescue Organization
Name of Animal Shelter
Website of Online Advertisement
Name of Breeder
Where and when did you find this animal?
Do you have a current veterinarian?

YesNo
Please provide the veterinary clinic name below
Have you scheduled an appointment to have your animal altered?

YesNo
Would you like assistance with a referral to local veterinarians?
Would you like to add an additional animal for vouchers?

YesNo
About Your 3rd Animal
Animal #3 Name
Animal Age
Animal Gender

FemaleMale
Pet Species

CatDogRabbitOther
Please provide more information on the species of your pet.
When did this animal join your household?

MonthDayYear
Date
Where did the animal(s) you are requesting a voucher come from?

Rescue OrganizationAnimal ShelterOnline AdBreederFoundOther
Please provide more information on your answer of "other"
Name of Rescue Organization
Name of Animal Shelter
Website of Online Advertisement
Name of Breeder
Where and when did you find this animal?
Do you have a current veterinarian?

YesNo
Please provide the veterinary clinic name below
Have you scheduled an appointment to have your animal altered?

YesNo
Would you like assistance with a referral to local veterinarians?
Would you like to add an additional animal for vouchers?

YesNo
About Your 4th Animal
Animal #4 Name
Animal Age
Animal Gender

FemaleMale
Pet Species

CatDogRabbitOther
Please provide more information on the species of your pet.
When did this animal join your household?

MonthDayYear
Date
Where did the animal(s) you are requesting a voucher come from?

Rescue OrganizationAnimal ShelterOnline AdBreederFoundOther
Please provide more information on your answer of "other"
Name of Rescue Organization
Name of Animal Shelter
Website of Online Advertisement
Name of Breeder
Where and when did you find this animal?
Do you have a current veterinarian?

YesNo
Please provide the veterinary clinic name below.
Have you scheduled an appointment to have your animal altered?

YesNo
Would you like assistance with a referral to local veterinarians?
Voucher Program Guidelines
Most veterinary clinics in Southern Indiana and Louisville accept FCARL vouchers. You will be responsible for checking with your veterinary clinic prior to your appointment as to whether they accept FCARL vouchers.*

I agree
FCARL voucher are valid for 3 months from the date of issue. If you are unable to redeem your voucher within that timeframe then voucher is void and you will have to reapply.*

I agree
Are there other unaltered animals in your home that you are NOT requesting a spay/neuter voucher for? If so, please list their species, age and the reason why you are NOT requesting a spay/neuter voucher for them currently. *
Any other information you want to include on your application?
I have read and agree to the voucher qualifications. By submitting this application, I agree that it has been completed in good faith. I understand that incomplete applications and/or the submission of false information may result in my application being denied.*

I Agree
Signature (Use your mouse to sign below)*

Clear
Should be Empty:

Spay/Neuter Voucher Application

Primary Contact Information

Financial Information

Photo Identification

About Your Voucher Needs

About Your Animal

About Your 2nd Animal

About Your 3rd Animal

About Your 4th Animal

Voucher Program Guidelines