C4H

Application

* Required Fields

General Information

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Service

Medical

Post-Traumatic Stress Disorder
Traumatic Brain Injury
Depression
Anxiety
Other
N/A
Yes    No

Pet Information

Yes    No
Yes    No
Yes    No

Additional Information

Required Documents

Please Note: If these documents are not submitted application cannot be processed.

Please upload one of the following documents/ identification proving your status (Active Duty, Retired, Veteran, Firefighter, Law Enforcement).

  • DD Form 214
  • Retired ID card
  • Active Duty ID card
    •

If you do not have a copy of your DD Form 214, you may request a copy from the National Archives Veterans’ Service Records.

If you don’t have a digital copy of your forms, you can fax them to:
(703) 997-0599.

Thank you for taking the time to complete the C4H application for a companion animal. A C4H representative will contact you within 3 to 5 business days to conduct a standard application interview. Once the interview is complete you will be notified via email whether your application has been approved or denied. Upon receiving the approval email notification you may then work with local shelter and rescues for your companion animal. C4H is unable to provide the benefits of the companion animal program for individuals who adopt prior to receiving the formal approval from a C4H representative.

Once your companion animal has been adopted, C4H will reimburse you for the adoption fee that you paid to the shelter or rescue directly and provide a free gift card for supplies within 14 days of C4H being notified by you of the adoption. A formal receipt will need to be sent in to your C4H representative for the reimbursement check and gift card to be sent out.

In addition, any questions or concerns regarding your companion animal should be brought to the attention of your C4H representative in a timely manner so we can assist with any issues.

I understand that my local shelter staff maintains the authority to determine which animal I am best suited to adopt due to predetermined traits and behavioral tendencies of the animal. Any misleading or untrue statements on this application will result in immediate denial of any C4H services and incentives. By my signature or submission of this form, I verify that the above information is accurate and true. Lastly, I give C4H consent to share my personal information with local shelter staff, C4H supporters, and C4H staff.

Yes    No