802.598.1263 | 802.598.3462 emmasfoundation@yahoo.com

EMMA’S FOUNDATION FOR CANINE CANCER, INC
Application for Assistance

Emma’s Foundation for Canine Cancer raises funds for dogs who due to the owner’s/caretaker’s financial constraints, would not be able to have or complete cancer treatment without assistance. Assistance is based on proven financial need.

Please note that Emma’s Foundation is ONLY able to help New England and Florida Residents at this time.

DO YOU QUALIFY FOR ASSISTANCE?

You are a GOOD candidate if:
  • You live in New England or Florida
  • You provide your pet with routine veterinary care
  • You have taken your pet to a specialist/veterinary and have a written cancer diagnosis
  • You can provide proof of financial need
  • Your pet has received a survival diagnosis of fair or better
You are NOT a good candidate if:
  • You are looking for help with diagnostic’s or end of life
  • Your pet has already been treated and you are looking for funds to repay a loan or credit card
  • You have been convicted of animal abuse or neglect
  • Your pet has not been seen by a veterinarian in the last 2 years
  • You do not have a cancer diagnosis from a veterinary or oncologist
  • The animal is not in your legal custody
  • Your pet’s prognosis is guarded or poor

Please fill out the form below, or if you prefer, you can print the application here.
 

    About You

    * = required fields

    Are you currently employed?*

    YesNo- If no, please mail unemployment letter to: Emma's Foundation, PO Box 1115 Milton, VT 05468-1115

    Do you own your own home?*

    YesNo

    About Your Dog

    Dogs Gender*

    MaleFemale

    Is your dog spayed/neutered?*

    YesNo

    *Please do not give vaccinations to a dog with cancer! If your dog is due for rabies, we will provide a waiver form.

    Have you applied for assistance to pay for your dog's treatment from Care Credit?*

    YesNo

    Your Veterinarian Currently Providing Treatment

    Have you given your vet permission to speak with Emma's Foundation about your dog?*

    YesNo

    * If we call your clinic and they have not received your permission, your application will be denied.

    Emma's Foundation recipients are required to contribute as much as they can toward treatment., and to also help with fundraising. Start now putting aside any funds you can apply towards treatment.