IV4A Rescue Intake Form

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Welcome to Indy’s Voice 4 Animals’ Moore Life Medical Fund grant process. We are excited to be able to expand our services for helping animals in need of medical care and support. This process expands IV4A’s capabilities to provide monetary assistance to help offset veterinary care costs for animals with medical issues who are pulled from Indianapolis Animal Care Services (IACS). The Moore Life Medical Fund grant is available to all-volunteer, 501c3 animal rescues organizations. A rescue organization is able to apply for up to $1,500 per calendar year (no limit on the number of animals pulled from IACS).

Please completely fill out the application form below as best you can. Once the form is completed and submitted, we will respond within five days on the status of your application. If there are any questions that we have regarding your application, we will reach out to you via the contact information you provided on the form.

If you receive an error on the Intake form please make sure you correct it before re-submitting. Please don’t use refresh since it will refresh everything and you will need to start over.

Thank you for your interest in IV4A’s Moore Life Medical Fund grant and helping to save an animal in need!

Welcome to Indy's Voice 4 Animals Grant Process form

Rescue Organization name*

Rescue organizations applying for a grant must be all-volunteer 501c3 in order to qualify.

Applicant's Name*

First

Last

Email address*

Phone Number*

The Phone number can be entered as XXX-XXX-XXXX or XXXXXXXXXX.

City*

State*

Zip*

Veterinary Clinic Name*

Veterinary Email Address*

Veterinary Phone Number*

The Phone number can be entered as XXX-XXX-XXXX or XXXXXXXXXX.

Dollar Amount requesting*

Enter the amount (example = $125.45) from the Veterinary Invoice.

Reason For Applying*

Animal's Name*

Location where Animal was rescued*

At this time we are only allowing this process to be used to pull animals from Animal Care and Control.

Animal Type*

Gender*

Approximate Age*

Animal Story (if any)*

Photo/Video Upload

Upload any photos or videos you may have at this time.

Photo/Video Upload

Upload any photos or videos you may have at this time.

Invoice Upload

Upload your Vet Invoice. Even if it's an estimate at this time.

Invoice Upload

Upload your Vet Invoice. Even if it's an estimate at this time.

This field should be left blank