Current Status My monthly household income is* My employment status* EmployedUnemployed I receive the following assistance UnemploymentSSIDisabilityFood Stamps (SNAP)Section 8 HousingOther I am currently homeless* YesNo Number of people in my household* Your Information ---AlaskaAlabamaArkansasAmerican SamoaArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriNorthern Mariana IslandsMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUtahVirginiaVirgin Islands, U.S.VermontWashingtonWisconsinWest VirginiaWyoming Pet's Information DogCat MaleFemale Health issues, if any Check here if you need to apply for another pet. Second Pet's Information DogCat MaleFemale Health issues, if any Check here if you need to apply for another pet. Third Pet's Information DogCat MaleFemale Health issues, if any How did you hear about the Roanoke Valley SPCA Spay/Neuter Clinic?*