Missouri Department of Agriculture

Spay and Neuter Grant Application

Please DO NOT include any personal, confidential, and/or sensitive information in your responses on this form (e.g. social security number, credit card information, health information, account number, etc.).
Facility Information
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Contact Person
Last Name*
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* * Zip code*
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Primary Phone*
Phone 1
Phone 2
Phone 3
E-mail Address
Confirm E-mail Address
Confirm E-mail Address
Describe Agency
Organization Structure *
Service Provided *

Attending Veterinarian
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Do you have an exisiting program with your attending veterinarian that includes a lower cost or discounted plan? *

Type of Entity
What county(ies) does your Spay/Neuter Program cover and what is the population of each?*
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What criteria does your organization use in determining financial needs of individuals? *
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Describe and quantify, to the extent possible, the pet overpopulation problem in your community using your agency's data and any other meaningful estimates. *
For your organization, in the last completed year. *

Dogs
Cats
Admitted
Adopted
Sterilized
Euthanized
If your program performs adoptions, are all animals sterilized before adoption? *


Does your organization currently have a spay/neuter program? *


Provide the number of procedures performed over the past year by your organization / agency. *

How many animals were spayed/neutered through your organization/agency during the last year?*

Has your organization received a grant from the spay/neuter fund in the past? *
How many procedures were performed with the grant?

Is this funding planned for expanding or enhancing a program?

Does your organization shelter animals? *




Describe the general socio-economic need (e.g. poverty levels, unemployment, per capita income, occupational data, etc.) of the counties covered by your spay/neuter program. *
Describe what community collaborations, if any exist and how this grant will foster the creation or extension of those collaborations. *
What other resources for spay/neuter assistance exist in your community and who are their target populations? *
If grants from other organizations are anticipated, please tell us from whom and how much has been requested or awarded.
Explain how post-surgical monitoring and care will be managed. *
How would a grant increase the number of spay/neuter procedures in your community? *
Please describe your plan to promote the "I'm Pet Friendly" license plate. * (Attach images to support your plan)
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