Type your information in the fields below then select the "print" option on your browser. Rescue Group NameAddress Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail Confirm Email Website (if any)Make certain that everything you type below appears on the printed copy before closing this window.Briefly describe your and your group's proposed project and how it relates to education, advertising/promotion, or medical/veterinary care of Border Collies currently in rescue or foster homes.Briefly describe your or your group's proposed project and how it relates to education and/or advertising/promotion.Fund Use:Please provide an accounting of how you intend to use the funds to advance your proposed project. To add additional rows, click on the + .DescriptionAmount Please provide copies of the following documents, if available.1. Documentation of not-for-profit status from the state where incorporated (if available).2. A list of Board members and officers and list of volunteers (if a group). 3. A list of dogs taken in and their current status (e.g. adopted, euthanized, still in foster care) over the past two years. 4. An accounting of expenditures over the past two years. This accounting does not have to be detailed, but does need to indicate how much income has been generated through adoption fees, donations and fundraising efforts and how much has been spent on supplies, dog care, etc. 5. Copies of adoption applications and contracts, plus written documentation of screening procedures.I have read and agree to the terms of the application for rescue funds. Applicant SignatureDate:BCSA Member SignatureDate:Mail to: BCSA Treasurer, c/o Karen Mull, 916 Rabbit Hill Road, Lititz, PA 17543Office Use Only: Date ReceivedForm Rev 3.2006