Fill Out the Application Form

Complete our online form below to request monthly deliveries of free dry food for up to two dogs or cats in Cedar Rapids, Marion or Hiawatha. Explore the criteria for applying, and discover what to expect as a client of Cedar Rapids AniMeals.

Or, if you’d prefer, download a PDF of the Application Form to print, complete and mail to us at:

Cedar Rapids AniMeals
Attn: Client Coordinator
PO Box 11195
Cedar Rapids, IA 52410-1195

Contact Information


YesNo

Eligibility

** In order to be eligible for Cedar Rapids AniMeals you must have a caseworker at a Social Service Agency OR receive federal benefits.

YesNo

Please have your caseworker provide the Referral from a Social Service Agency listed below.

SSI-Supplementary Security Income - You must provide current year's Social Security Proof of Income (Benefits) Letter to receive services. Please mail to Cedar Rapids AniMeals.SSDI-Supplementary Security Disability Income - You must provide current year's Social Security Proof of Income (Benefits) Letter to provide services. Please mail to Cedar Rapids AniMeals.SS-Social Security - You must attach current year's Social Security Proof of Income (Benefits) Letter to provide services. Please mail to Cedar Rapids AniMeals.

Companion Pet Information

**Cedar Rapids AniMeals will provide for up to two pets (cats or dogs only) in a single household. Please indicate companion pet(s) to receive services.

Companion Pet #1

DogCat
FemaleMale
YesNo
YesNo
YesNo
YesNo

Companion Pet #2

DogCat
FemaleMale
YesNo
YesNo
YesNo

Privacy Statement and Liability Waiver

I consent to the use of the attached evidence of eligibility to be used by Cedar Rapids AniMeals to verify my eligibility for enrollment in Cedar Rapids AniMeals programs. I understand that this information is confidential and will be used by Cedar Rapids AniMeals only for the purposes of establishing my eligibility for the programs.

I agree to hold Cedar Rapids AniMeals, its directors, officers, employees, volunteers, and any party or employee of the aforementioned parties, harmless from any claim or loss which may be alleged to have been caused directly or indirectly to any person, animal, or things while a client of Cedar Rapids AniMeals.

I hereby certify that the information I have entered on this application is accurate and true.

I hereby certify that I have read, understand, and agree to the terms and conditions stated in the Cedar Rapids AniMeals Application for Enrollment.