Organization. Fax No hyphens, e.g

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1 Page 1 of 10 Stage 1 of 1 Proposal for Equine Organizations Organization Please review the information below for accuracy and edit accordingly. You may return to your application at any time by clicking the "Save and Finish Later" button at the end of the application. Please DO NOT use all capital letters. Organizational Information GFAS Status If not applicable, skip to the next entry. Organization Name Mailing Address - Street City State <Select One> Postal Code Phone No hyphens, e.g Fax No hyphens, e.g Web Site Federal Tax ID/Employer Identification Number (EIN) Tax Status <Select One> Organization Type Physical Address (if different than mailing address) Include address, city, state and zip/postal code. Leave blank if physical and mailing address are the same.

2 Page 2 of 10 County in which the facility resides Mission Statement Year Incorporated (if unknown, input N/A) Number of Full-time Staff Number of Part-time Staff Number of Current Active Volunteers Contacts Primary Contact Person for this Request Prefix e.g. Ms., Mr., Dr. <Select One> First Name Last Name Suffix Title Head of Organization (CEO/Director/President/Founder) Prefix First Name Last Name Suffix Title Proposal

3 Page 3 of 10 Request Information Project Title Please provide a short, descriptive title for this request, e.g. Fencing for Quarantine Corrals Request Amount e.g Project Budget What is the total cost of this project? (e.g. 9500) Project Description Provide a detailed description of your funding needs in 250 words or less. Do not describe your organization or its mission. If you know estimated or actual costs for line items, be sure to include these costs in your description. Program Area Please select the program area most closely aligned with this funding request. Geographical Area Served (for THIS grant request ONLY ). Choose your domicile location in the FIRST drop-down. You may choose additional locations if this grant would benefit your work outside of your own state. Population Served (for THIS grant request) You may choose more than one, but ONLY select those populations that will be served by THIS request. For example, if your organization provides services for equines and farm animals, but your request is for equine paddocks, you should choose "Equine" ONLY. Type of Support Programs and Services Briefly describe the types of programs your organization provides the community it serves (in 100 words or less).

4 Page 4 of 10 Collaborations What other animal groups do you work with regularly? List the organization names, contacts, addresses and phone numbers. If you received the FULL grant amount requested, approximately how many animals would this grant impact? Estimated Impact: Equines Estimated Impact: Farm Animals Estimated Impact: Wildlife Estimated Impact: Cats Estimated Impact: Dogs Estimated Impact: Birds Estimated Impact: Rabbits Facility Information (Check all that apply) Own your facility No Lease your facility No Use foster homes No If leasing, how many years are left on the lease/contract? If not leased/owned by the organization, who holds the lease for the property your facility is on? If you utilize foster homes, how many do you have on average? How old is your facility? How old is your facility's most recent renovation? Maximum Holding Capacity of Equines Maximum Holding Capacity of Other Animals

5 Page 5 of 10 Describe number and type of paddocks/enclosures. Equine Numbers Total number of current equine residents: Number available for placement: Number recovering: Number of permanent residents: Intake History Number received 1 year ago: Number received 2 years ago: Number received 3 years ago: Number born at facility 1 year ago: Number born at facility 2 years ago: Number born at facility 3 years ago: Number placed/adopted 1 year ago: Number placed/adopted 2 years ago:

6 Page 6 of 10 Number placed/adopted 3 years ago: Number died/euthanized 1 year ago: Number died/euthanized 2 years ago: Number died/euthanized 3 years ago: Number returned 1 year ago: Number returned 2 years ago: Number returned 3 years ago: Number of permanent residents 1 year ago: Number of permanent residents 2 years ago: Number of permanent residents 3 years ago: Policies and Relationships Does your organization have a disaster plan? Please explain. Euthanasia What is your policy on euthanasia? Do you provide euthanasia services to horse owners in your community? Breeding Do you allow breeding?

7 Page 7 of 10 Professional Memberships What professional memberships does your organization hold (also note if your organization is accredited or verified a sanctuary by Global Federation of Animal Sanctuaries)? Investigation Who is responsible for investigating horse abuse in your county? Include contact information. Jurisdictional Authority for Cruelty Cases If this is a seizure/cruelty case, under whose jurisdiction does it fall? Please list the name of the entity and individual(s). Jurisdiction What is the address of the jurisdictional authority? Jurisdiction Phone What is the phone number of the jurisdictional authority? References - List professionals who have firsthand knowledge of this organization. Primary Vet Name Primary Vet Primary Vet Phone Number Farrier Name Farrier

8 Page 8 of 10 Farrier Phone Number Purpose of Funding Summary Utilization of Funds Detail how the funds would be utilized. Over how many months do you estimate the requested amount would be used? (In whole months) Please enter either 6 or Grant Timeline/Budget Include a timeline and budget for utilizing this grant. Mission Advancement Describe how this funding will help advance the mission of your organization. Evaluation State the plans for evaluating the project, including how success is defined and will be measured. Future Funding Include the plans for funding the project in the future.

9 Page 9 of 10 Description of Finances Current Year's Estimated Revenue Current Year's Estimated Expenditures Previous Year's Actual Revenue Previous Year's Actual Expenditures Please explain any estimates greater than 10% of the previous year's actual numbers. If not applicable, please write "N/A" Current Budget for the Entire Year Last Year Annual Budget Funding Sources Describe your organization's major sources of funding, both current and past. Previous Grants List each grant you received within the last 24 months, including amount, purpose, and granting agency.

10 Page 10 of 10 Fundraisers List all major fundraising events and campaigns. Include the NET dollar amount raised. Generally, how large is your financial cushion? Select the most appropriate response. Succession Plan What is your succession plan for determining the founder/e.d.'s successor or dissolving the organization? Please Note If this grant request is approved, please indicate the status of your current cash reserves or available credit to cover the costs of your proposed project while waiting for payment from the ASPCA. By submitting a letter of inquiry and/or an application for an ASPCA grant, you agree to allow the ASPCA to utilize the information submitted on such letter of inquiry/application in any way it deems appropriate to support its mission to prevent cruelty to animals. Such uses may include, but are not limited to, reproducing such information in print or on the ASPCA website and/or allowing third parties to access such information. In addition, by submitting this letter of inquiry and/or application, you hereby certify that the requesting organization is aware of and endorses this request and the information herein.