[Pinal County] New Hope Partner Application

New Hope Partner Application

Name of Organization

Organization Email

Organization Website

List names and contact information required above for all other officers of the organization.

Other Organization Officers

Group President or Director

Director Phone

Director Alternate Phone

Contact for Quarterly Reports

Quarterly Reports Phone

Quarterly Reports Alternate Phone

Quarterly Reports Email

The Adoption Partner authorizes the following persons to enter into an agreement for a New Hope adoption from Pinal County Animal Care & Control and to remove animal once formally adopted.

Name 1

Position 1

Phone 1

Email 1

Name 2

Position 2

Phone 2

Email 2

Name 3

Position 3

Phone 3

Email 3

Additions or deletions to the above authorization must be submitted in writing from the organization president or director.

Please provide primary and secondary veterinarian information:

Primary Clinic Name

Primary Clinic Phone

Secondary Clinic Name

Secondary Clinic Phone

Describe where the animals will go after they leave Pinal County Animal Care & Control, but before a permanent home is found:

Describe your adoption process. Please include how and where you perform adoptions:

Reference Name 1

Reference Years Known 1

Reference Address 1

Reference Phone 1

Reference Name 2

Reference Years Known 2

Reference Address 2

Reference Phone 2

Reference Name 3

Reference Years Known 3

Reference Address 3

Reference Phone 3

Please provide the following information to the best of your ability:

Official notice of 501C3 status or veterinary hospital premise license, as applicable.
Articles of Incorporation and By-laws or Application for Employer Identification Number (Form SS -4), If Articles of Incorporation and By-laws are unavailable EIN Number Non-profit Certificate of Disclosure (ARS Section 10-3202. D.)
Any articles or published information regarding your organization Any additional information you feel may be relevant in support of your application.

The information you have provided will assist us in processing your application. Thank you for your time and willingness to save animals lives through the New Hope Program. We look forward to your participation.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.