​Before Applying

• The ACF is NOT a government sponsored program.

• Professional diagnosis, appropriate treatment and in many cases required medication are donated by the owner of the veterinary member clinic.  The clinic is not reimbursed by the Foundation and their donation is not tax deductible. 
• Only one animal per family for the life of the animal is eligible.
• Veterinary member clinic contribution commitment per client is up to $250/year for one pet per family.
• The Animal Care Foundation has $100 available per animal per calendar year to use to supplement the $250 pledged by the member clinic if further care is needed.  The clinic will make the arrangements to access these funds if they are needed.
• No funds may not be used to cover previously incurred veterinary expenses.
• In order to allocate resources the program Coordinator may not always refer the client to the same member clinic.
• It is the client's responsibility to set up an appointment with the veterinary member clinic following the initial referral made by the program coordinator.
• The client is responsible for finding transportation to the assigned veterinary member clinic.
• The client is expected to provide the veterinary member clinic with any vaccination records, an accurate history, any previous diagnoses or current medical conditions, and a detailed description of symptoms.
• Once a diagnosis is determined and a treatment plan established it is the client's responsibility to carry out the prescribed treatment plan.
• The client must maintain appropriate control of the pet during the clinic visit.
• ​The client is responsible for the portion of the bill in excess of the amount contributed by the veterinary member clinic.
• The Animal Care Foundation and its member clinics reserve the right to refuse service to any client whose behavior affects the safety, security, comfort, or well-being of ACF staff, clinic staff or clients or their animals.

​

Qualification Requirements

To qualify for service an individual:

    1. MUST be a resident of Hennepin, Dakota, Anoka, or Washington County
    2. MUST be Blind or Disabled or 65 years or older
    3. MUST show financial need.  Your household income for the number of persons in your household cannot exceed the below schedule.

                        Number of Persons                    Total                           
                            In Household               Annual Income*                                             
                                    1                             $17,226           
                                    2                             $23,274                                       
                                    3                             $29,322                                              
                                    4                             $35,370                                              
                                    5                             $41,418                                                  
                                    6                             $47,466                                                
                                    7                             $53,514                                      
                                    8                             $59,562                                                                                                                                *135% of 2020 Federal Poverty Guideline
       4.  MUST not have any other pet currently enrolled in the program

Requirement 1:  Proof that you reside in Hennepin, Washington, Dakota, or Anoka Counties.*** You MUST provide proof by sending a copy of ONE of the below.
A.  Driver’s license, Passport or picture ID with your current address.
B.  Utility bill or Bank Statement showing your name on the account with your current address.
C. Social Security Disability (SSD or SSDI) or Supplemental Security Income (SSI)  
     Award Letter or Bank Statement showing your current address.
D.  Major VA Disability Award Letter showing your current address.
E.  If you are homeless, fill out and sign the last page on the application.


Requirement 2: Proof that an adult individual is Blind, Disabled or 65 or more years old. 
*** You MUST provide proof by sending a copy of ONE of the below.

A. Picture ID showing your birthdate showing your age as 65 years or older
B. Birth Certificate showing your age as 65 years or older
C. Driver’s license with birthdate showing your age as 65 years or older
D. Passport showing your age as 65 years old or older
E. Social Security Disability (SSD or SSDI) or Supplemental Security Income (SSI)  
     Award Letter or Bank Statement showing Direct Deposit of SSD or SSI
F.  Major VA Disability Award Letter equal to or greater than 50%
G.  SMRT Certification from the State of MN or MNChoices Plan showing SMRT certification (we only need the page with the SMRT box checked).
H.  Letter showing enrollment in MA-EPD (Medical Assistance for Employed Persons with Disabities).


Requirement 3: Proof that an adult individual is in need of subsidized veterinary service
*** You MUST provide proof that you are enrolled in ONE of the following programs and that your total household income meets the guidelines in the table at the beginning of this section by sending a copy of one of the below.

A. Supplemental Security Income (SSI) Award Letter or bank statement showing direct deposit of SSI.
B. Medicaid (Minnesota Medical Assistance) - Include a copy of your Minnesota Health Care Program Membership Card.
C.  SNAP Enrollment Form (Food Stamps)
D.  Letter showing you are enrolled in MSP (Medical Savings Program) managed by the state of Minnesota.
E.  Letter showing the state or county is paying your Medicare premiums.

​Requirement 4: This application must be filled out completely and submitted with all of the supplemental materials ​

After Application Has Been Submitted

Once your application materials have been submitted and reviewed you will be contacted by the ACF Coordinator.

​If approved:
* You will be contacted by the ACF Coordinator, assigned an ACF client number, and given information to contact the appropriate veterinary member clinic.
* It is up to you to contact the veterinary member clinic, set up an appointment, and arrange for your own transportation. 

If NOT approved:
The Coordinator will contact you with the reason you were not approved. You may re-apply if appropriate.

REMEMBER *** EVERY CLIENT NEEDS TO SUBMIT AN APPLICATION AND SUPPORTING DOCUMENTATION ANNUALLY *** ​

What you need to know: The ACF veterinary member clinics receive no compensation from any government program or a tax deduction for the services and goods they donate. The ACF veterinary member clinics have limited resources and occasionally a referral cannot be made even when a person qualifies. Each veterinary member clinic retains the right to refuse a referral. ​

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