Apply Background InformationName* First Last Title*Name of Organization*Address of Organization* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone*What is the Applicant’s status? Check applicable line.*IndividualNon-Profit OrganizationFor ProfitStateIf you selected Non-profit Organization, please include the state you are registered in.EIN NumberIf you selected Non-profit Organization, please your EIN numberFundraising InformationWhat is fundraising needed for? Describe the issue in detail.*What is the fundraising goal?*Please include the monetary fundraising goal and / or the type and estimated value of any donations of goods or services. How will funds or in-kind donations be expended or used by the Applicant?*Will this fundraising goal meet all the needs of applicant?*YesNoIf the Applicant is fundraising for a specific dog or program; e.g., surgery for a foster, supplies to help forever fosters, money to negotiate the rescuing of a dog, etc., will the funds, goods or services raised be sufficient to undertake and maintain the project or programIf you answered no to the question, please identify them and explain how these resources will be acquired.Is this fundraiser for a specific dog(s)?*YesNoDog’s Name:Breed:Approximate DOB:Sex:Microchip Number:Signature*Terms of Acceptance and Electronic Signature*I, the applicant for help from Pug Squad, warrant the truthfulness of all information provided in this application and agree to abide by the terms set forth by Pug Squad. I also certify that I have read and understand all questions and statements on this application. I understand that submitting this application does not guarantee that I will receive financial assistance from Pug Squad. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.