National Animal Care & Control Association Course/Training Application Form

Applicants must currently work in animal welfare in an enforcement capacity or with field services duties.

Applicant Information

Last Name*

First Name*

Are you a current NACA Member? YesNo

Is your agency a current NACA Member YesNo

Organization or Agency Name*:

Position, Title or Rank*:

Organization Mailing Address(1)* Organization Mailing Address (2)

City*

State*

Zip*

Preferred Telephone Number*:

Alternate Phone:

Your email*

Date of Birth*: M/D/Y

Gender:

Race:

Course/Training Seeking Scholarship For*:

Organization Statistics/Information

Population of Jurisdiction (City or County)

Number of Team Members:

Full Time

Part Time

Contract

Volunteers

Annual Intake:

Dogs

Cats

Others

Annual Calls for Service:

Cruelty Total

Dangerous Dog

Nuisance

Annual Organization Budget:

Annual Training Budget:

Current Programs (Check all that apply):

Adoption ProgramFoster ProgramBehavior/EnrichmentCruelty InvestigationDangerous Dog InvestigationCommunity Outreach/EducationPublic Spay/Neuter

Type of Scholarship Requested (Check all that apply):

TrainingProtective EquipmentDisaster FundsOther

Please explain how scholarship funding will support your agency and its training program.

Are you seeking and would be ok with: FULL ScholarshipPARTIAL Scholarship

Would you be unable to attend without a full scholarship? YesNo

Would you be unable to attend without a partial scholarship? YesNo
If yes, what’s the minimum amount?

Applicant Areas of Expertise

Years of Service*

Other Trainings Attended*

In 250 - 500 words please tell us how this training will benefit you, your organization, and the animals in your community?

NACA represents Animal Control and Animal Welfare professionals from all across the country. This includes individuals from a wide variety of organizations with varied clientele, demographics, resources, services provided, etc. We understand these diverse challenges and want all potential applicants to know, individual answers will be weighted based on creativity and passion and not on performance of any individual's organization. Please fill out the essay to the best of your ability (in the language in which you feel most comfortable) and with information you feel comfortable sharing with NACA

STATEMENT OF ACCURACY FOR STUDENTS

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. By signing below my supervisor and I acknowledge the time commitment of the course applied for and commit to attending barring any unforeseen emergencies.

Scholarship Applicant Name*:

I Affirm Date Submitted:

Supervisor/Director Name*:

I Affirm Date Submitted:

Email Address of Supervisor/Director*:

By submitting this application you are agreeing to have your email address included in future NACA or ASPCA Animal Control Communications.