STAY Program Assistance Application

Huntington County Humane Society

390 Thurman Poe Way
Huntington, IN 46750
260-356-0355

STAY PROGRAM ASSISTANCE APPLICATION

Standing Together for Animals and You

A program of the Huntington County Humane Society

STAY helps Huntington County families access resources that may help keep their pets safe, healthy, loved, and at home.

Please complete the application below so our team can learn more about your household, your pets, and the assistance you are requesting.

BEFORE YOU APPLY

Residency: Applicants must live in Huntington County to be eligible for financial assistance.

Proof of Income: Please provide proof of household income. Acceptable documentation may include a Disability or SSI statement, unemployment statement, paycheck stubs from the previous four weeks, or your most recent tax return.

If you do not have one of these documents, contact the STAY Program Manager at Melissa@huntingtonhumane.org.

Review Time: Applications may take up to 10 business days to review.

Approval: Approved applications are valid for 30 days. Only one approved STAY application per household per year is permitted.

Please list ALL pets currently living in your household, even if you are not requesting services for every pet.

PLEASE CHECK YOUR SPAM/JUNK FOLDER
Our response may occasionally be filtered by your email provider.

APPLICANT INFORMATION

First Name *

Last Name *

Date Of Birth *

Street Adress *

City *

State *

Zip Code *

Email Address *

Confirm email *

Phone Number *

HOUSEHOLD & FINANCIAL INFORMATION

Total Household Income *

Number of Adults in Your Home *

Number of Children in Your Home *

Do you receive any form of assistance?

EBT

WIC

Reduced/Free School Lunch Program

Social Security Disability Income

Energy Assistance

Medicare

Section 8

Major VA Disability

Other

None

If you selected Other, please list the assistance you receive.

PROOF OF INCOME REQUIRED

Please attach proof of household income with your application.

Acceptable documentation may include:
• Disability or SSI statement
• Unemployment statement
• Paycheck stubs from the previous 4 weeks
• Most recent tax return

If you do not have any of these documents, please contact Melissa@huntingtonhumane.org before submitting your application.

Upload Proof of Income - Photo or Screenshot Upload Proof of Income - PDF

YOUR PETS

PLEASE LIST EVERY PET IN YOUR HOME

For each pet, please include:
• Name
• Age
• Sex
• Cat or Dog
• Spayed/Neutered?
• Breed
• Services Needed

Services may include: Vaccines, Testing, Wellness Care, Spay/Neuter, Pet Food, Behavioral Support, Crisis Foster, Other, or None.

List ALL pets currently living in your household, even if you are not requesting services for every pet. *

Do you have a current veterinarian? *

Please provide the name of your current veterinarian. If you do not have one, enter N/A. *

Veterinarian Phone Number, if known

WHAT HELP DO YOU NEED?

What type of STAY assistance are you requesting? Please check all that apply.

Pet Food Assistance

Low-Cost Spay/Neuter

Vaccinations

Testing

Wellness Care

Short-Term Crisis Foster

Training/Behavioral Support

Other

If you selected Other, please describe what assistance you are requesting.

Please provide a brief description of your current situation and why you are requesting assistance. *

Without assistance from STAY, are you currently considering surrendering or rehoming your pet? *

Is there anything else we should know about the urgency of your situation?

WHAT HAPPENS NEXT?

STAY applications may take up to 10 business days to review.

Our team may contact you, your veterinarian, or other service providers if additional information is needed to determine eligibility or coordinate approved services.

Submission of this application does not guarantee assistance. Services are based on eligibility, available resources, program funding, and individual circumstances.

AGREEMENT & SIGNATURE

STAY PROGRAM CERTIFICATION & AGREEMENT

By submitting this application, I certify that the information I have provided is accurate and complete to the best of my knowledge.

I understand that STAY assistance is intended for qualifying pet owners experiencing financial or temporary hardship and that submission of this application does not guarantee approval or assistance.

I understand that the information provided on this application may be verified before assistance is approved.

I authorize Huntington County Humane Society and its representatives to contact veterinarians, service providers, or other parties as reasonably necessary to verify information or coordinate approved STAY services.

I understand that Huntington County Humane Society cannot guarantee the outcome of veterinary treatment, medical procedures, behavioral services, foster care, or other services provided through the STAY Program.

BEFORE YOU SUBMIT

Please make sure you have:
• Listed ALL pets currently living in your household
• Included your current household income
• Selected all forms of assistance you receive
• Uploaded proof of income, if available
• Explained what type of STAY assistance you are requesting
• Reviewed your contact information for accuracy

Please check your spam or junk email folder after submitting your application.

I have read and understand the STAY Program Certification & Agreement above. I certify that the information provided in this application is accurate and complete, and I understand that assistance is subject to eligibility, verification, available resources, and program funding. *

Applicant Signature

Date *

Helping Pets & People STAY Together ❤️🐾

Thank you for applying for assistance through STAY - Standing Together for Animals and You.

Our team will review the information you provided and determine what resources may be available to help you and your pet.

APPLICATION REMINDER

Submission of a STAY application does not guarantee approval or assistance. Services are based on eligibility, available resources, program funding, and individual circumstances.

Applications may take up to 10 business days to review.

Please watch your email, including your spam and junk folders, for communication from our team.

Huntington County Humane Society

390 Thurman Poe Way • Huntington, Indiana 46750
260-356-0355

STANDING TOGETHER FOR ANIMALS AND YOU