Application for Accreditation If you are providing either temporary or lifetime care for animals, or you are an individual concerned about the plight of abused and homeless animals, we want to hear from you.
MEMORIAL GIFTS Memorial gifts to ASA's Animal Rescue Fund are urgently needed. For more information about this very special form of giving, call Vernon Weir, Development Director, 702-804-8562 If you wish to apply for accreditation by ASA, please right click the pages, select print, complete the applications and send to: Application for Accreditation c/o The American Sanctuary Association 2340 Sterling Heights, Las Vegas, NV 89134 Please review the policies before submitting this form. Date:__________ Name of Organization:____________________________ Street address:__________________________________ City:____________________ State:_______ Zip:________ Telephone:__________________ Fax:___________________ Director:____________________ Title:____________________ Email Address:__________________
Web site: ______________________ The purpose of this organization is: (use attachment if necessary) 1.) How long has your organization been in operation?__________ 2.) Please submit a copy of your federal tax exemption letter. 3.) Please submit a copy of your articles of incorporation and bylaws. 4.) What are your organization's monthly operating costs?__________ 5.) Briefly describe your source of income:__________________________ 6.) How many employees does your organization have?__________ 7.) How many volunteers does your organization have?__________ 8.) Does your organization provide a safety program for staff and volunteers?_____ Please attach description.
9.) Does you organization have a safety program in case of animal escape or other emergency? Are staff members trained to use capture equipment? Please attach description. 10.) Submit your organization's written protocol regarding the use of controlled drugs, including emergency procedures when a licensed veterinarian is not present. 11.) Does your organization keep detailed animal records?_____yes_____no 12.) Please submit a list of permanently housed species, and a list of species you may be able to accept for sanctuary placement in the future. 13.) Please describe your facility and include photographs or video tape. 14.) Please submit the name, address and telephone number of attending veterinarians. 15.) Please submit details of your veterinary care program. 16.) USDA license #_______________ 17.) State wildlife permit #_______________ 18.) U.S.D.I. Fish & Wildlife Service permit #_______________ 19.) Other permits and numbers you may be holding_______________ 20.) If you have a working relationship with other sanctuaries or animal protection groups, please submit the name of these organizations, the name of the person you work with, and his/her phone number. 21.) Please check below the type of educational activities your organization conducts: __________Guided tours __________Off-site presentations __________Special lectures __________Radio / TV programs __________Other (please specify) 22.) Does your organization breed animals?____yes____no (if yes, please attach explanation, and include the disposition of these animals). I the undersigned, swear that the information given in this application is true to the best of my knowledge. If accepted as a member of the American Sanctuary Association (ASA), this organization agrees to abide by its policies and guidelines. I am aware that if this organization violates any of the ASA's policies and guidelines, membership may be terminated immediately. Signature____________________________Date___________ Title___________________________ State of_____________________ County of___________________ Subscribed and sworn to and before me on this_____day of_____year_____ Notary's Payroll Signature____________________ Notary's Typed or Printed Name____________________ Next