Helping Hooves, Paws, & Claws

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Needs Assessment Questionnaire And Survey

Helping Hooves, Paws, & Claws

Providing Animal Welfare Services

 

Needs Assessment Questionnaire and Survey for

Helping Hooves, Paws, & Claws

Providing Animal Welfare Services

Please answer the following questions to help us plan for future services.

Do you own a Pet in need?

____Breed____________ How Many____

How do you need assistance? Or of what assistance many benefit you or someone you know the best. (If selecting more than one please indicate by numbers of importance Starting with 1)

_____In Home Care (while you are ill, recovering, etc)

_____Assistance in food, shelter, or veterinarian bill

_____Foster Care for Pet (while you're are in hospital, etc)

_____Transportation of pet to vet or groomer

_____ Other (attach explanation)

If you do own a pet, please indicate your interest in using services if they existed in your community.

_____Very Likely

_____ Likely

_____Maybe

_____Not Likely

_____Not Interested

If you do NOT own a pet, do you know of someone that could use this service?

_____ Yes

_____  No

_____ Maybe in the future

_____Request more information (please indicate address, e-mail, phone for contact)

If you do/or know someone that this service would benefit, which service would be Of your interest to support, donate to or help in volunteering or encouraging others to donate to help. Please indicate highest to lowest, starting with 1 as highest service to be of benefit in our community.

_____ Veterinarian Fund (health care expenses, or transport to vet)

_____Food Fund

_____Shelter Fund (adequate housing, fencing, heat in winter, etc.)

_____In Home Care (assisting while owner is sick, or elderly with pet, etc)

_____ Foster Pet Care (housing a pet for someone in hospital or rehab)

_____Other (Do you know of other services that may benefit our community)

_______________________________________________________________

 Do you know of someone that had to but an animal to death because they could not afford medical are? _____Yes            _______No

 Do you know of someone that had to give there animal away because of no money for food. _______Yes                _______No

 Do you know of someone that's animal was taken away and if they were offered help it could have remained home?_______Yes            _______No

 Have you ever had an animal official come to your door reporting a problem and give you a referral to call for assistance to correct the problem?______Yes  ______No

If Yes, how did this help. If No, how could it have helped?

______________________________________________________________

______________________________________________________________

Other Items of importance you feel should be addressed for the humanity of animals.

______________________________________________________________________

______________________________________________________________________

Are you interested in being a volunteer?

Frequency (Once a day, twice a week, etc.)

_____Staff Volunteers

_____In Home Care Program     

_____Foster Pet Care Program

 _____Fund Raising Events                                    

_____Material Organizers

_____Help Find Community Support       

_____Other (Please specify)                                  

Please add additional information you think is important to help us determine needs for animals in our community.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Your participation is highly appreciated and your name will remain private at your request to privacy. Our survey is need in accountable numbers for our census and will assist us in providing care need and obtaining grants for improvements to help all animals receive humane care.

OPTIONAL,

for additional information, updates, tax receipts, or notification of upcoming events.

Name_____________________________________________Date_________________

ID or SS # (optional for donation tax record if receipt needed) _____________________

Street__________________________________________________________________

City___________________________________________________ZIP_____________

Phone _________________________________________________________________

E-Mail_________________________________________________________________

Indicate if you want future updates and preference of mail, phone, or e-mail. (circle)

Thank you for your assistance in this survey. Please return it to the address at the below or drop it off at participating location.

Contribute of your support or donation by check or money order will be greatly accepted

Send to:   HHPC                                                                                 website: HHPC.4t.com

1045 Wooded Acres Drive                                      e-mail: PAWS@hhpc.4t.com

Hardy, Va 24101

With all charitable donations, you will receive end of year totals for tax filings. Please indicate if you need a federal tax ID or social security number included on receipt for your records. Or foundation is a nonprofit corporation and waiting approval of the 501(c) 3 and your support will be of the greatest benefit. The survey assists us in grant applications to help provide the care for animals, and assist in improving our programs.

Helping Hooves, Paws, & Claws

Providing Animal Welfare Services