Spay/Neuter Assistance Application Form

Thank you for spaying/neutering your companion animal. Spaying and neutering presents many health benefits for pets.

The Gunnison Valley Animal Welfare League (GVAWL) offers assistance to those for whom spaying a pet is a financial hardship. Through the generosity of our local veterinarians, private and municipal grants including the assistance of the Public Service Grant Program of the City of Gunnison, and our fundraising efforts, we have established a pool of funds available for this purpose. Please understand that this amount may vary year-to-year, and that certificates are only issued as funding will allow.

Upon approval of your application by GVAWL, the coupon you will receive is accepted by most Gunnison Valley veterinarians. Because of funding sources, preference is given to residents of Gunnison County.

You will be notified as promptly as possible as to whether GVAWL can provide you with assistance at this time. GVAWL will make final determination based on:

GVAWL reserves the right to deny assistance based on lack of available funding or an incomplete application.

You may also complete a Spay/Neuter Assistance Application online at http://gvawl.org or download the Spay/Neuter form in PDF, fill it out, and send it to us. Electronic submission of the application is considered acceptance of all conditions of the program.

Gunnison Valley Animal Welfare League
98 Basin Park Drive – PO Box 1834
Gunnison, CO 81230

Spay/Neuter Assistance Application

Name

Address

Apt, suite, etc.

Country

City

State

Zip code

Home Phone

Cell Phone

Email Address

Do you live within Gunnison city limits?

Yes

Don't know

I am requesting a Spay/Neuter Assistance Program Coupon in the amount of (choose ONE only):

Cat Neuter Coupon for $45 off cost of the procedure

Cat Spay Coupon for $65 off cost of the procedure

Dog Neuter Coupon for $100 off cost of the procedure

Dog Spay Coupon for $125 off cost of the procedure

I am applying for:

Cat Neuter

Cat Spay

Dog Neuter

Dog Spay

Dog spay only

Yes

Does this dog weigh over 40 pounds?

Yes

Applicant - please read carefully before submitting:

I am applying for a Spay/Neuter Funding Certificate through the GVAWL Spay/Neuter Assistance Program. I
understand that this program is intended to provide financial assistance to those for whom spaying or
neutering a pet is a financial hardship.

Has anyone in your household applied for, or received, a GVAWL Spay/Neuter Funding Certificate within the past twelve months?

Yes

Household Income

Income Period

Monthly

Annually

Upon submission, I verify that the information above is true. If requested by GVAWL, I agree to provide documentation of my income and financial need.

Prohibition Against Discrimination. Any person who seeks to volunteer for or who receives services from the Gunnison Valley Animal Welfare League will not be discriminated against on the basis of ethnic background, color, religion, age, gender, or sexual orientation.
Rev Sep 2014

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Spay/Neuter Assistance Application

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