American Sanctuary Association (ASA) Application
If you wish to apply for accreditation by ASA, please download our printable version (pdf format) of the application, complete the application and send to:
Application for Accreditation
Please review the policies before submitting this form.
Name of Organization: ____________________________________________
City: ______________________ State: _________ Zip: ________________
Telephone: (____) _________________ Fax: (____) ____________________
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
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,
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? ____________
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. __________________________________
1. If you have a working relationship with other sanctuaries
or animal protection
2. Please check below the type of educational activities your
3. Does your organization breed animals? _______ yes ______
Note: Please check if you primarily provide?
___ wildlife rehabilitation and release services,
Additional information may be required.
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.