Test of Funding Request

Rescue Organization Name *

Amount Requested for Reimbursement *

Please submit estimates or invoices separately to efulghum@paradigm-eng.com

Preferred Method of Contact *

• Phone
• E-mail

Contact Person *

First

Last

Email *

Phone Number *

Address *

City *

State *

Zip Code *

Request from which Fund? *

• General ACAR
• CHARMS

CHARMS requests for dogs over 7 years old

Akita's Name and Age *

Where was the dog acquired *

Has the Akita been evaluated? *YesNoThird Choice

Is the Akita deemed adoptable? *YesNo

Reason for grant request *

Emergency care, boarding, general vet care, transport, etc. If requesting a grant for vet car, transport, boarding/kennel care, please provide a copy of an estimate. This should be followed by an actual invoice showing that you used the funds for the requested purpose.

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