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Emergency Placement Partners Application

Emergency Placement Partners are perhaps the most crucial element in The HSUS's national mission to rescue abused animals.

The HSUS Emergency Placement Program is not only about the placement of victims from cruelty and neglect, it is about the partnership.  Our partners often times respond with us on the ground during large scale cruelty cases and disasters, work on community level issues and stay up to date on state and federal level initiatives.  All of this is optional of course!  Becoming a partner does not mean that you have to take animals or participate in cases, it means that you have the option.  Our partners network with other shelters and rescue groups across the country on best practices and innovative techniques in sheltering and adoption.

Do you want to join our exciting coalition?  Submit your application below!

ORGANIZATION INFORMATION
Choose the description that best fits your organzation
Is the organization a registered 501(c)(3) non-profit?
Enter your tax-exempt ID #
What is your annual operating budget?
How many years has the organization been in operation?
Does the organization have liability insurance specific to animal welfare organizations?
What is the organization's annual animal intake?
What is the organization's annual number of adoptions?
What is the organization's spay/neuter policy?
Is the organization able to transport multiple animals?
What type of vehicle is used for transport (e.g., ventilation, air conditioning, heat, stationary caging, etc.)
How far in miles are you able to travel to pick up animals?
CONTACT INFORMATION
REFERENCES

List the veterinary clinic and veterinarian associated with the organization that we may contact for a reference

List other shelters or animal welfare organizations currently working with that may be contacted for a reference

DOCUMENTS
You may upload documents with this form or mail them

The Humane Society of the United States
Emergency Placement Partners Program
Attn: Kim Alboum
PO Box 775
Pittsboro, NC 27312
Email: kalboum@humanesociety.org
 

As part of the application process, please provide any ONE of the following documents:

  • Last annual report to the State Veterinarian
  • Last similar or applicable report to other local or state regulatory agency
  • Last inspection report from local regulatory agency
  • Letter of endorsement from national or regional breed association
  • Letter of reference from a licensed veterinarian AND letter of reference from another local humane organization, local government officials or state professional association

Please provide ALL of the following documents (required for nonprofit organizations and as applicable for other agencies):

  • Mission statement, by-laws and written policies (with a focus on core policies rather than daily operations)
  • 501(c)(3) letter of determination
  • Adoption application form
  • Adoption contract
  • Foster agreement form (only if applicable)
  • Informational material or brochure
  • List of board members with contact information
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
Files must be less than 10 MB.
Allowed file types: jpg jpeg pdf doc docx.
If there is any additional information you would like to provide please do so here