Guidelines and Application for Dink Fund


DINKS MEMORIAL FUND a fund of Yorkshire Terrier National Rescue, Inc. (YTNR) A 501 (c)(3) non profit organization.

Dinks Memorial Fund is dedicated to the memory of a little yorkie named Dink who now resides at the Rainbow Bridge. This fund was founded to provide financial assistance to pet owners with yorkies in need of emergency veterinary care.

YTNR relies soley on individual donations made to the Dink Memorial Fund. Assistance is determined by the availability of funds at the time of need. Eligibility requirements are based upon (1) medical urgency, (2) financial need, (3)available funds.

An applicant applying for a grant must provide:

1. The most recent copy of their 1040. (gross and net income pages)
a. Unemployed and Disabled applicants must provide proof of unemployment or disability.

2. A report from the vet with a diagnosis, prognosis and treatment, with estimated costs for the specified yorkie.

3. Photo's and updates to the Dinks Fund.
* The above information must be faxed to 615-746-2113 within 24 hours along with your completed application.

4. Incomplete applications will not be accepted for review.

5. False or misleading information on an application will result in immediate withdrawal of monetary assistance. The applicant will be notified of the withdrawal, and if Dinks Funds has disbursed any monies toward veterinary care, the applicant will be held responsible to repay the amount in total back to Dinks Fund.

6. If your application is approved, it applies only for the condition for which you have requested funds.

7. All approved applicants will provide regular updates. A minimum of one email every third day on your dogs condition is required until the case is closed. Failure to provide updates will result in closure of the case without prior notice and all funds will be suspended.

8. Dinks funds will be disbursed only to the attending veterinarian.

Please fill out the form completely. Incomplete forms will be deleted. Please fill in your e-mail address and personal information. This information is private and will not be given out to anyone other than a Dink Fund representatives in order to process your application.

Press the 'send' button when you are done. For correction before sending, press 'oops' If the form isn't working, please just e-mail Us the information.

(Please don't use a P.O. Box for addresses, we need an actual location)



Have you applied for financial assistance with any other organization?:
If so, please explain below:



Your Name:

Your address: City:

State: Zip Code:

Home phone: Work phone:

Cell phone: Email:

Your Pets Name: Is your pet a Yorkie:

Please tell us your Pets Diagnosis. You must include the emergency treatment your pet needs. Please give as much detail as possible.


This application is only for life threatening emergencies. What is the total amount shown on your estimate for the emergency care your pet needs?

Of the total amount needed for emergency treatment, how much of this will you pay?

Does your Vet have Care Credit available?

You are required by YTNR to apply for Care Credit if your vet has it available. Have you applied for Care Credit?
Yes, and I was Denied
Yes, and I was Approved
My Vet does not have Care Credit

If you applied for Care Credit and were approved, how much were you approved for?

What is your annual income?

How many credit cards do you have?

How much credit do you have available?


Please list 2 personal references (No Relatives please):

Reference 1
Name:
address:
City: State: Zip:
phone: email:


Reference 2
Name:
address:
City: State: Zip:
phone: email:


Name of Hospital or Clinic:

Name of Veterinarian:

Address:Street

City, State & Zip:

Phone:

Fax:

Is this a 24 hour facility?

Name of contact person at the vet?


YTNR's Payment Policy is as follows:
YTNR cannot assist with charges incurred prior to approval of application.
YTNR cannot pay for treatment in advance, nor can we pay a deposit.
YTNR cannot reimburse you for payments made to the veterinarian.
YTNR will call the veterinarian's office and make payment after services are completed.
YTNR's payment will consist of the amount received in donations,
if any, plus our pledge, if any.

Has your Vet agreed to work with YTNR's payment policy?

Additional Comments:



Press send only once!


Apply for Care Credit

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2016 / Contact us at Dink Memorial Fund
All graphics and information on these pages belong solely to YTNR.
Please don't copy or remove anything from these pages.

Dinks Memorial Fund for Compassionate Care is a Fund of Yorkshire Terrier National Rescue, Inc.
We are a 501(c)(3) organization and all donations are tax deductible. A receipt will be sent.
Thank you for your support.