Portal

After you submit this form, our staff will review you application and confirm you qualify for our program. You may be contacted to clarify your information. While waiting to have a voucher issued, we recommend you get your pet up to date on their vaccinations. Most places require your pets are current on their vaccinations before they will accept the animal. You can get all required vaccinations for one low cost by visiting the Pawsitive project.

Once your receive a voucher, it is your responsibility to contact the veterinary office, groomer or trainer of your choice to scheduled an appointment. It is important to discuss the final cost of these services with the provider before confirming your appointment. The voucher is issued for the portion of the service that Capital Humane Society will contribute - this is not the final price you will pay!

Appointments must be scheduled before the expiration date listed on the voucher. The service does not need to be completed before the expiration date. It is also your responsibility to transport your pet to the service provider for their appointment.

What type of assistance voucher are you requesting?*

Landlord Name or Company*

Landlord Contact Information*

Landlord Mailing Address*

Landlord Zip Code*

Would you like to apply for additional Spay/Neuter Assistance through Lincoln Animal Ambassadors? Your application information will be shared so that you do not have complete a separate application.

First Name*

Last Name*

Phone Number*

Address*

City:*

State*

Zip Code*

Age*

Email Address*

Have you used our Pawsitive Impact Program?*

Current Veterinarian

Will you be able to print your voucher?*

Please complete this information for each pet. You can add additional pets by clicking on the "Add New Entry" link.

A Type	B Name	C Breed/Description	D Gender	E Age	F Weight	G Altered	H Vaccinated

Add New Entry

Are you currently receiving assistance from any of the following assistance programs?

None

EBT or SNAP

WIC

Medicaid

Medicare

Section 8 Housing

Section 20 Childcare

Social Security or Disability

You will need to provide an approval notification document from one of the qualifying government assistance programs to be approved for this program. Verification documents can be submitted with this application using the browse option below.

Completing the form on a smart phone to take or upload pictures of your documents directly on the application.

Additional Documents can also be emailed to paws@capitalhumanesociety.org

To qualify for financial assistance, you must provide one of the following:

1. Currently receiving SNAP – SNAP Card/Documentation of Benefits

2. WIC – WIC Card/Documentation of Benefits

3. Medicaid – Medicaid Card/Documentation of Benefits

4. Medicare – Medicare Card/Documentation of Benefits

5. Section 8 – Documentation of Benefits

6. Section 20 – Documentation of Benefits

7. SSI – Documentation of Benefits

Document Upload*

Take Picture/Video