If you wish to apply for accreditation by ASA, please click on the Printable Version link to download a
printable pdf version of the application, complete the applications and send to:
Application for Accreditation
c/o American Sanctuary Association
2308 Chatfield
Las Vegas, Nevada 89128
Please review the policies before submitting this form.
Date: ________________
Name
of Organization: ____________________________________________
Address:
____________________________________________________________
City:
______________________ State: _________ Zip: ________________
Telephone:
(____) _________________ Fax: (____) ____________________
Director:
____________________________________________________________
Title:
_______________________________________________________________
Email
Address: ________________________Web Site: _______________________
The
mission of this organization is: (use attachment if necessary)
Financial
and Corporate Information
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 the monthly operating costs of your organization?
_____________________
5. Describe your primary sources of income. ___________________________________
________________________________________________________________________
6. Please attach a copy of your most recent year-end financial
statement and / or federal
990 report.
7. How many employees, full and part-time, does your organization
have? ___________
8. How many volunteers? __________________________
9. Please attach a list of your board members, a brief description
of their qualifications,
and explain if they are active in their duties.
10.
If you are the sanctuary founder or co-founder, has your board
of directors created a comprehensive plan for the future management
and income of the organization in the event that you are no
longer capable of directing the corporation? Please explain.
11.
Do you have a life insurance policy payable to the corporation,
an endowment, or adequate membership / donor list? Please provide
details.
12. Do you have liability insurance? ________ How much? ____________
Please
provide the name and address of the insurance carrier.
Animal
Care and Facilities
1.
Does you organization have a safety program to manage an animal
escape or other emergency? ___________ Are staff members trained
to use capture equipment? ___________ Please attach description.
2. Does your organization keep detailed animal records? ______
yes ______ no
3. Please submit a list of permanently housed animals (number
and species), and a list of animals you may be able to accept
in the future for sanctuary placement.
4. Please describe your facility and include photographs or
videotape. Include information about the number of acres owned,
who owns the land and facilities (individual or sanctuary),
when the land was bought, and what type of property surrounds
your facility (rural, farmland, residential, etc.). If you have
plans for future expansion, or relocation, please also include
this information.
5.
Please submit the name, address and telephone number of attending
veterinarians.
6. Please submit details of your veterinary care program.
Licenses
and Permits
1.
USDA license # (include copy of last inspection). ____________________________
2.
State wildlife permit # (include copy of last inspection). _______________________
3. U.S. Fish & Wildlife Service permit number. _____________________
4. Do you have special permits under local zoning ordinances?
________ Please explain.
5.
Other permits and licenses
you may hold. __________________________________
Miscellaneous
Questions
1.
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.
2. Please check below the type of educational activities your
organization conducts:
___________ Guided tours
___________ Open to the public (please include hours of operation)
___________ Off-site presentations
___________ Special lectures
___________ Radio / TV programs
___________ Other (please specify)
3. Does your organization breed animals? _______ yes ______
no
(if yes, please attach explanation, and include the disposition
of these animals)
Note:
Please check if you primarily provide ?
