State-Wide SNAP Program

Statewide Spay/Neuter Voucher Program (SNAP)

Since 1986, the MSPCA, in cooperation with the Massachusetts Veterinary Medical Association (MVMA), has offered eligible pet owners a discount certificate accepted by nearly 200 veterinary hospitals and veterinary clinics throughout Massachusetts.
Learn more about SNAP
Information for Veterinarians

SNAP Application

PLEASE FILL OUT THE FORM BELOW IF YOU ARE ALSO APPLYING FOR JAMAICA PLAINS' SHALIT-GLAZER CLINIC IN RESPONSE TO THE RECENT POSTING OF ADVERTISEMENTS ALONG BOSTON'S BUS ROUTES

SNAP is intended to assist low-income pet owners afford the cost of spaying or neutering their dog and/or cat. The Massachusetts Society for the Prevention of Cruelty to Animals (MSPCA) in cooperation with the Massachusetts Veterinary Medical Association (MVMA) offers eligible pet owners a discount on spay/neuter surgery. Reduced SNAP fees are made possible through generous donations of time and resources by participating veterinarians who believe in the importance of spaying and neutering as part of a complete pet healthcare program.

In order to apply for assistance, simply fill out this form completely, you will be notified about your eligibility for SNAP within 2 weeks of the time your application is received.

Purebred dogs and cats are generally ineligible for SNAP and applications are usually denied. Please call the office or include additional information in your application, if you think that your circumstances may warrant an exception. (617) 541-5007

You may only apply for your own dog and/or cat. If you have more than one pet that needs to be spayed or neutered, please include that information about the other pets that need assistance.

Please make sure your pet is up to date on necessary vaccinations (shots) PRIOR to the surgery. SNAP does NOT offer a discount on the fees for shots.

If you need help completing this form, please call (617) 541-5007. Incomplete applications will delay processing your request.

IMPORTANT

Please read before filling out application.

Please fill in all fields. If a field does not apply to you, please type in "N/A" or "0". Applications take 2 weeks to process. Incomplete applications may take longer than 2 weeks to process.

Please complete the following:

Name:

First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from MSPCA-Angell.

Remember me. What's this?

Please enter your total current household take-home pay (please enter a whole number with no decimal point or $ sign):

Question - Not Required - $/week

Question - Not Required - $/per two weeks

Question - Not Required - $/per month

*5.

Question - Required - Please enter any other income per month (including public assistance, alimony, interest income, etc)

*6.

Question - Required - Please check all of the public assistance programs in which you participate

	Food stamps
	Medicaid
	Federal Supplemental Security Income (SSI)
	Aid to Families with Dependent Children
	Rental assistance
	Fuel assistance
	Social Security
	Women, Infants and Children (WIC)
	Unemployment benefits
	None

*7.

Question - Required - Other program (please describe)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Do you live with others?

Household Members: Please list below all household members, INCLUDING YOURSELF, who rely on the above stated income. Indicate full-time (FT) or part-time (PT) for those employed; student, unemployed, retired, etc. where applicable.

*9.

Question - Required - Your name:

(Maximum response 255 chars, approx. 5 rows of text)

10.

Question - Not Required - Your age:

*11.

Question - Required - Your occupation:

12.

Question - Not Required - Your status:

13.

Question - Not Required - Household Member name:

14.

Question - Not Required - Household Member age:

15.

Question - Not Required - Household Member occupation:

16.

Question - Not Required - Household Member status:

17.

Question - Not Required - Household Member name:

18.

Question - Not Required - Household Member age:

19.

Question - Not Required - Household Member occupation:

20.

Question - Not Required - Household Member status:

*21.

Question - Required - Please choose one that best describes your housing status

*22.

Question - Required - Monthly rent/mortgage/board $

PLEASE ENTER INFORMATION ABOUT YOUR PET

*23.

Question - Required - Pet's name

*24.

Question - Required - Dog or cat?

*25.

Question - Required - Male or female?

*26.

Question - Required - Weight

27.

Question - Not Required - Breed

28.

Question - Not Required - Color/Markings

29.

Question - Not Required - How did you get this pet?

30.

Question - Not Required - If this pet is a female, has she had any litters?

31.

Question - Not Required - If yes, how many?

What is your pet's age? If your pet is less than one year old, please just enter the number of months.

*32.

Question - Required - (Years)

33.

Question - Not Required - (Months)

34.

Question - Not Required - Where is the veterinary practice located?

35.

Question - Not Required - If you already have a veterinarian for this pet, please enter the name of your veterinary practice

Is your pet up-to-date on the following shots?

36.

Question - Not Required - Rabies? Yes
No
Don't know
N/A

37.

Question - Not Required - For cats: FVRCP ("distemper"?) Yes
No
Don't know
N/A

38.

Question - Not Required - For dogs: DHLPP ("distemper"?) Yes
No
Don't know
N/A

*39.

Question - Required - How long have you had your pet?

40.

Question - Not Required - If you have a cat, do you let if go outdoors unsupervised? Yes
No
N/A

41.

Question - Not Required - Do you have any other pets?

42.

Question - Not Required - If yes, how many other cats?

43.

Question - Not Required - If yes, how many other dogs?

44.

Question - Not Required - Are these pets spayed/neutered?

*45.

Question - Required - If NO, please include information about the other pets that need spay/neuter assistance. You must include ALL OF THE FIELDS BELOW FOR EACH PET:..... NAME / AGE / MALE OR FEMALE? / BREED / COLOR / CAT OR DOG? / WHERE YOU GOT THE PET? / HOW LONG HAVE YOU HAD THE PET?

(Maximum response 255 chars, approx. 5 rows of text)

46.

Question - Not Required - How did you hear about SNAP?

(Maximum response 255 chars, approx. 5 rows of text)

47.

Question - Not Required - Please include any further information that would clarify your need for financial assistance.

*48.

Question - Required - I understand that the SNAP program is for low-income pet owners only. I certify that the information on this application is accurate. Please check "Yes" to indicate your signature. Yes
No

The Mission of the Massachusetts Society for the Prevention of Cruelty to Animals–Angell Animal Medical Center is to protect animals, relieve their suffering, advance their health and welfare, prevent cruelty and work for a just and compassionate society. ©2012 MSPCA-Angell