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Gulf Coast Relief Application

Reimbursement of Emergency Expenses for
Gulf Coast Veterinarians who support struggling pet owners
Application Instructions

* Effective thru September 30, 2010 *

Award Purpose:
In response to the record number of pets filing into shelters and increasing need along the Gulf coast, the American Veterinary Medical Foundation (AVMF) has partnered with Hill’s Pet Nutrition and Merial’s Paws to Save Pets Program to support veterinary clinics and shelters affected by struggling pet owners who are unable to provide food and medical care for their pets.

The Gulf Coast Pet Relief Program is part of AVMF’s Animal Disaster Relief and Response Fund (ADRR), a fund designated to support state and national disaster relief efforts. This effort will offer aid to 90 clinics and five shelters in the Gulf region. Applications will be reviewed by the AVMF’s Grants and Awards committee in October, 2010 after all applications have been received. Funding will be based on the number of applications received and indicated need.

Criteria for Eligibility:

  1. Must be a licensed veterinarian or staff member, such as a licensed veterinary technician.
  2. Must have provided for the medical care of animal victims of the disaster listed on the application.

Application Procedure:
Applicants must apply electronically, using the form below. If you cannot electronically file your grant application please call the AVMF office at 800-248-2862 ext. 6691 and request that a form be mailed to you. Include your name, your phone number, and complete address when calling.

Checks will be payable to the person/entity named in the form. Please note that incomplete forms will be returned.

** If you are awarded a grant, we would like to see your photos (via e-mail only), for marketing purposes, but it is not mandatory.

Deadline:
Applications must be received no later than September 30, 2010.

Organization Name or
Name of Veterinary Clinic
Treating Animal Victims : 
Tax Exempt Status : 
 501(c) (3)
 501(c) (6)
Tax Identification No.
Total Number of Animals Treated : 
Veterinary Clinic Number
(see gulf coast pet relief program
fact sheet on avmf website) : 
Amount Requested : 
Total Amount Needed : 

Applicant Information

Name (Last, First, Middle) : 
New Applicant : 
 Yes
 No
Veterinary Degree(s) : 
License(s) and state(s) where
licensed as a veterinarian : 
Check all that apply : 
 AVMA Member
 State VMA Member
 Other Professional Membership
AVMA Member Number : 

Address of organization

Address : 
City : 
State : 
Zip : 
Phone : 
Fax : 
Email : 

Address for sending check

Position Title : 
Name as it should appear on the check : 
Address for sending check : 
City : 
State : 
Zip : 
Phone : 
Fax : 
Email : 
 
 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 grant is awarded as a result of this application.
 
Please provide a short narrative explaining your involvement in providing care to animal victims of the disaster(s). Heartwarming stories are welcomed, as well as photos and video of you or your staff helping animal victim(s)! Alternatively, please provide no more than a one-page narrative on letterhead, if available. Please type, or write legibly so the reviewers can fully appreciate your situation. You may email documents and photos to us.