MHWC Assistance Application

MHWC Assistance Application

To request assistance, please complete the form below in its entirety and MHWC will be in contact with you within 48 hours. Incomplete applications cannot be submitted or processed. If you are having problems submitting the application, please download this application form to your computer, edit the form, and email it directly to info@minnesotahorsewelfare.org. You may also print off the form, fill out the information, and send it directly to: Minnesota Horse Welfare Coalition, P.O. Box 606, 300 2nd Street East, Hastings, MN 55033-1206
Name

First NameLast Name
First Name
First Name
Last Name
Last Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Have you ever received assistance from the MHWC in the past?
If so, please give the approximate date you applied?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What type of assistance do you need?

Other
How many horses need assistance?
Are the horses on your premises?
If not, where are the horses?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Basic background information
Have you been contacted by animal welfare authorities with concerns about your animals?
Are there stallions on the property?
If yes, are you willing to have them gelded?
Are there pregnant mares or mares in foal on the property?
Name of your veterinarian

First NameLast Name
Date of last veterinarian care (if you know)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of last dental work (if you know)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Will you allow a representative of the Welfare Coalition to contact your veterinarian about your horse(s) ?
Name of your Farrier or hoof trimmer

First NameLast Name
Date of last hoof trim or farrier work (if you know)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Describe assistance needed
What is immediate concern regarding your horses?
Please provide a description of your financial need and assistance request.
The MHWC grants provide temporary assistance for emergency or short-term support to help horses in need. What is your specific plan to manage this situation in the long run?
How did you hear about the Minnesota Welfare Coalition's assistance programs?
If requesting euthanasia assistance or hay assistance, please fill out the additional questions below. Be sure to complete the checkbox at the end and hit the SUBMIT button, or MHWC will not recieve your application. MHWC will respond to you within 48 hours.
Euthanasia Assistance

Euthanasia grants are offered to assist with costs associated with euthanizing equines and facilitating a peaceful transition. Euthanasia grants help lift some of the financial burden for owners and rescues throughout Minnesota. Many horses suffer unnecessarily when responsible owners, that have fallen on hard times, do not have the means to do the best thing for the animal. Euthanasia assistance supports the community in several ways — allowing reimbursement to veterinarians, providing disposal services on behalf of community members, and assisting equine rescues in our state. MHWC provides resources to help community members and rescues afford end-of-life decisions and provide equines with a compassionate, dignified end.

Fill out this section only if you are seeking euthanasia assistance. After completing this section, scroll down and submit the form.
Name of horse
Age
What are the circumstances that led to your decision to euthanize your horse?
Hay Assistance

Fill out this section only if you are seeking hay or feed assistance. After completing this section, scroll down and submit the form.
Hay grants are available for temporary, short-term help. The Minnesota Horse Welfare Coalition provides approved funds directly to your hay vendor. The hay vendor is required to complete a W9 form to be eligible for the hay grants.
How long will your current hay supply last?
Castration Assistance

Fill out the next section only if you are seeking castration assistance. After completing this section, scroll down and submit the form.
The castration funds are paid directly to the veterinarian who is doing the procedure. The castration application must approved by MHWC before castration services are provided.
How many of your stallions need castration? If there are 3 or more, you may be eligible for an onsite clinic.
What is the age (if known) of the stallion(s)? Are they halter broke and have they been handled?
Has your stallion been diagnosed as cryptorchid (undescended or retained testicle(s)?
By submitting this application, I agree to be bound by the terms below.

By submitting this application and requesting and/or receiving hay, feed or other equine assistance or transaction, you specifically agree, on your behalf and on behalf of your heirs, executors, assigns, not to bring any legal action in any court of law or equity against the Minnesota Horse Welfare Coalition or any of its affiliated, related or member organizations, volunteers, agents or designees under any theory of liability arising from your application, request and/or receipt of hay, feed or other equine assistance or transaction.

You further agree to indemnify and hold the Minnesota Horse Welfare Coalition and its affiliated, related or member organizations, volunteers, agents or designees harmless from a breach of these terms.
Upload photo of horse / condition

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MHWC Assistance Application

Basic background information

Describe assistance needed

Hay Assistance

Castration Assistance