This application must be completed in one online session. Please consider printing out the application, drafting your answers offline and saving them on your desktop. When you are satisfied with your responses, return to the website to cut and paste your responses into the online application form. You will then have a saved document with your responses that you can use to reference your application or to have in your records should you run into any technical difficulties.
2012 Disaster Training Sponsorship Request
Application Instructions
Purpose:
Sponsor state, regional or national sessions aimed at ensuring disaster preparedness for the assistance and veterinary care of animals before, during, and following a disaster.
Awards:
Up to $5,000 can be issued per session. No more than one session per year per organization will be sponsored by the AVMF. All awards will be based on merit and availability of funds.
Eligibility:
- Sessions must be offered to an audience at the state, regional, or national level.
- Veterinarian(s) must be speakers, trainers, and/or intended participants.
- Each recipient of this award will be provided with a slide containing the AVMF logo, contact information, and a brief description of what the AVMF supports. Recipient must agree to show this slide at the session.
- Recipient must agree to put the AVMF logo on printed materials regarding the session.
- Recipient must provide a survey to the audience and e-mail its results to AVMF.
- At the completion of the program the recipient must provide a summary of the training session. The report should include:
- A breakdown of how AVMF funds were spent
- Final funds raised from additional sources
- Attendance numbers and audience demographics
- A copy of the program
- Any photos taken at the training session
Criteria for merit:
Applicants must apply using the online form. Type in all areas indicated on the form. If not applicable, state as such. Applications will be scored on the following criteria:
- Involvement of disaster and emergency management leadership (Department of Agriculture, State Veterinary Medical Association, Office of Chief Animal Official, state, regional or local animal health agencies, etc.)
- Submission of proposed agenda, reports and/or photos
- Fundraising efforts
- A definitive timeline
Deadline:
Applications must be received on or before midnight CENTRAL TIME on April 30, 2012. To be eligible for a 2012 award, the training session must be held before August 31, 2013.
Submission Process:
Complete the online form. If you have any questions, please contact Cheri Kowal, Programs and Administration Assistant, at ckowal@avma.org. Your subject line should read: AVMF 2012 Disaster Training-your state's 2-digit postal code-your organization name (For example, AVMF 2012 Disaster Training-IL-American Veterinary Medical Foundation). You may also call the AVMF office at 847-285-6691. |
Applicant Information |
Organization name
(name as it should appear on the check) : | |
Tax Exempt Status : | 501(c) (3)
501(c) (6) |
Tax Identification Number : | |
Session Name : | |
Amount Requested
(no more than $5,000) : | |
Today's date
(mm/dd/yyyy) : | |
Approximate Session Date
(must be before Aug. 21, 2013) : | |
Applicant's name : | |
New Applicant? | Yes
No |
Position Title : | |
Organization Information |
Address : | |
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State : | |
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Fax : | |
Cell : | |
Email : | |
Payment Information |
Send check to same address as above : | |
Address for sending check, if different from above : | |
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City : | |
State : | |
Zip : | |
Phone : | |
Fax : | |
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Applicant Assurance: I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil or administrative penalties. I agree to accept responsibility for providing any personal reports if a sponsorship is awarded as a result of this application. |
Answer the following questions. Appendices may be provided as applicable; please label appendices using sequential capital letters (i.e. Appendix A, B, etc.). Click on "UPLOAD" to add any appendices. |
1) State the goal(s) or purpose of the session, particularly as it relates to veterinarians. Describe why the session is relevant to disaster preparedness for the intended audience. Provide details on the disaster and emergency management leadership involved in the planning and execution of the session and the benefits to disaster and emergency management leadership if the session is held. Briefly summarize the success of past sessions in achieving these goals; a summary of survey results from attendees of the most recent session may be used, if available and applicable. A copy of a current and/or past survey, registration form, and/or advertisement may be uploaded. |
Upload File for Question 1 (Word, Excel, PDF) : |
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2) List the agenda for the session with speakers and key people organizing the session, date(s), and location(s); please be as detailed as possible. Indicate general qualifications of each speaker and/or key people organizing the session. Submit agenda with the speakers and key people organizing the session from the most recent event, if applicable. Flier(s) announcing the session(s) or a table summarizing this information may be uploaded. |
Upload File for Question 2 (Word, Excel, PDF) : |
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3) State the intended audience (demographics - veterinary professionals, animal control, law enforcement, etc,) and scope (state-wide, regional, national) of the session. Indicate the number of participants attending previous sessions, if applicable, and number of attendees expected for this session. |
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4) Indicate if certificates of attendance are provided to attendees. Indicate how many continuing education credits are available for attending veterinarians and/or veterinary technicians. |
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5) Describe the intended use of the $5,000 from the AVMF. Indicate how much each attendee is expected to pay to attend the session; also provide details on other funding sources and amounts. Estimate the cost to run the session with an accounting of how attendee fees, AVMF funds, and other sponsorship dollars are to be used; if an expense category is going to be covered by an in-kind resource, please indicate as applicable. |
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6) Briefly provide a timeline for your proposed program. The training session must be completed before August 31, 2013. |
