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 paula@flom.com. 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
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
What type of assistance do you need?

HayFeedGelding or castratingEuthanasiaHoof careVeterinary careSurrender or placementOther
How many horses need assistance?
Are the horses on your premises?

YesNo
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?

YesNo
Are there stallions on the property?

YesNo
If yes, are you willing to have them gelded?

YesNo
Are there pregnant mares or mares in foal on the property?

YesNo
Name of your veterinarian

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

MonthDayYear
Date
Date of last dental work (if you know)

MonthDayYear
Date
Will you allow a representative of the Welfare Coalition to contact your veterinarian about your horse(s) ?*

YesNo
Name of your Farrier or hoof trimmer

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

MonthDayYear
Date
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?
At this point in the application, you can scroll down to complete just the section for the specific assistance program you are applying for. Then complete the checkboxes at the end and submit. Someone will respond to you within 48 hours. Incomplete appications cannot be accepted.
Euthanasia Assistance

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 Bank 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. Please see guidelines. The Minnesota Horse Welfare Coalition Hay Bank 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.
Name of your hay supplier

First NameLast Name
Hay vendor phone number

Area CodePhone Number
Location of hay supplier

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long will your current hay supply last?
Do you agree not to sell, give away or transfer any hay you receive the was purchased through the Hay Bank?

YesNo
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 grants are paid directly to the veterinarian who is doing the procedure. The grant must be applied for and approved in advance of the procedure.

The Unwanted Horse Coalition offers castration assistance grants through their Operation Gelding program. As your first step, please contact them at this address http://www.unwantedhorsecoalition.org/voucher-program/ . For additional financial support, fill out the next section.
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)?

YesNo
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,

The Minnesota Hay Bank 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, the Minnesota Hay Bank and its affiliated, related or member organizations, volunteers, agents or designees harmless from a breach of these terms.
Upload photo of horse / condition

Browse Files

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Please verify that you are human*
If you are having problems submitting the application or get an error message, please email paula@flom.com. Or you may download this application form to your computer, edit the form, and send it directly to paula@flom.com. You may also print off the form, fill out the information, and send it directly to:Minnesota Horse Welfare Coalition P.O. Box 606300 2nd Street East Hastings, MN 55033-1206
Should be Empty:

MHWC Assistance Application

Basic background information

Describe assistance needed

Euthanasia Assistance

Hay Bank Assistance

Castration Assistance