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Application

Due to a decline in donations our grant amounts will be $75 - 100 and we are only accepting applications for cats with kidney disease (Mesa Fund) at this time. We hope to open our other funds when donations improve.

Your proof of income/financial need AND veterinary estimate must be faxed at the same time as you submit your online application. Applications received without these required documents will be automatically declined without consideration or reply.

Dear Applicants, please understand that due to the high volume of applications we receive and the limited staff we have, that it may take up to a week for us to respond to your application. As a reminder, we must receive all of your faxed materials before we can review your application. Thank you. - CIC Administrator

Cats in Crisis can not assist financially with the following:
  • Bills for treatment or services already rendered or incurred prior to approval of application
  • Payment for a cat being held at a vet hospital waiting for payment
  • Reimbursement for a bill/bills already paid
  • CIC cannot assist with a deposit
  • Routine care such as vaccination, dentals, general office visits, spaying/neutering/declawing
  • If you have received aid from CIC within the past 12 months
    • You may still be eligible to fundraise on our website
    • This stipulation does not apply to animal welfare organizations
The cat/kitten must:
  • Have a documented chronic medical condition requiring medical assistance, prescription food or medications
  • Be spayed or neutered
  • Be an indoor cat
  • Meet one of the following criteria to be considered
  • Be diagnosed with or strongly suspected by a vet of having one of the following:
    • Kidney Disease
    • Heart Disease
    • Thyroid Disease
    • Neurological Diseases
    • Mobility Problems
    • Life-threatening Conditions
  • Be currently up for adoption and have a diagnosed chronic medical condition
  • Have been adopted as a special needs cat within the past year

All fields must be completed for the application to be
considered complete and ready for review
Applicant Information
Last Name:
First Name:
Animal Welfare Organization (if applicable):
Address 1:
Address 2:
City:
State:
ZIP Code:
Home Phone:
Work Phone:
Cell Phone:
E-mail:

(Since our organization is internet-based, an e-mail address is mandatory. All communications will be via e-mail, we cannot return phone calls. Any application that does not have a valid e-mail address will have to be rejected. If for financial reasons you are unable to have an e-mail account at home, please consider using public internet access stations (such as those at your local library) to establish a free e-mail account with services such as Hotmail or Yahoo! Mail.

When, Where, & How did you acquire the cat (be specific):

List all current pets in your care and any conditions they may have:

List organizations you have contacted for assistance:

How did you find out about CIC?

Cat Information
Name:
Age:
Date of birth:
Sex:
Is cat spayed or neutered:
Physical description (color, weight, markings, etc.):

Describe illness or condition. Please be specific including when diagnosed:

Describe treatment or services required:

Veterinarian/Pharmacy Information
Clinic/Pharmacy Name:
Address 1:
Address 2:
City:
State:
ZIP Code:
Phone:
FAX:
E-mail:
Grant Information
Grant Type:
Mesa Fund - (Cats with kidney disease)
Stripes Fund - (Cats with heart or thyroid diseases)
Gillie Fund - (Cats with neurological or mobility problems)
Crisis Care Fund - (Special needs cats from/at a shelter)
Nine Lives Emergency Fund - (Critical, life-threatening conditions)
(The Mesa Fund is currently the only fund open to new applications. We hope to reopen the other funds at a later date.)
Estimated total cost of treatment/services needed:
Amount you are able to contribute:
Have you applied for Care Credit? Yes No
If yes, provide information on approval/disapproval:

Is your vet willing to discount services? Yes No
Describe your financial hardship:
Required Materials to Submit with your Application--
Please Fax your estimate and proof of income to 717-431-5544

Do not fax your application, submit it online.

  1. Proof of income. Any of the following are acceptable:
    (These are not required for humane organizations)
    • Copy of most recent tax return
    • Copy of most recent paycheck stub
    • SSI benefits
    • Disability benefits
    • Unemployment benefits & registration with a job search agency
    • W2 or 1099 from employer
      (When sending any of the above,
      please black out your SSN and bank number for privacy)

  2. Written estimate on veterinary letterhead
    Estimate must include the following information:
    • Organization's/individual's name
    • Cat's name
    • Diagnosis
    • Prognosis
    • Itemized breakdown of costs for procedures/treatments/care needed
    • Urgency of cat's condition

Your proof of income/financial need AND veterinary estimate must be faxed at the same time as you submit your online application. Applications received without these required documents will be automatically declined without consideration or reply.

Do you have your estimate ready to fax? Yes   No

Please do not submit your application until you have these ready to fax. Due to the volume of applications we receive daily, we must receive all parts of your application at the same time.

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© 2008 Cats In Crisis, Inc.
A 501(c)(3) Charitable Organization Founded November 2004