Veterinarian Relief
Application Instructions
Purpose:
Restoring the veterinary infrastructure affected by disaster.
Awards:
Currently up to $2,000 can be issued per grantee. Awards are not to cover personal property damage or income loss.
Criteria for eligibility:
- Must be a licensed veterinarian.
- Must show that financial hardship exists resulting in one or more of the following:
- Veterinary clinic damages.
- Inability for clinic to function more than 5 days after disaster.
Priority consideration will be given to:
- AVMA members.
- First time applicants.
- Practice owners.
- Full-time associates.
Application procedure:
Applicants must use the online application form. You will be contacted if your application is not complete.
Applicants can request up to $2,000. If the amount requested is insufficient to cover your needs, please note the final amount that would meet your needs and anticipate that the initial award will be no more than $2,000. Checks will be made to the person/entity named in your application.
* AVMF must be given permission to use the funded project for future recruitment of funds and receive acknowledgement for funding.
Submission Process:
Complete the online application form. If you have any questions while completing the application please contact Cheri Kowal, Programs and Administration Assistant, at ckowal@avma.org or 847-285-6691.
|
Applicant Information |
Name of Applicant : | |
Name of Veterinary Clinic : | |
Address : | |
| |
City : | |
State : | |
Zip : | |
Phone : | |
Fax : | |
Email : | |
Amount Requested $ : | |
Total Amount Needed $ : | |
Ongoing Funding Needs and
Estimated Time Frame : | |
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 |
Please specify other membership : | |
Position Title : | |
Payment Information |
Name as it should appear on the check : | |
Send check to same address as above : | |
Address for sending check, if different from above : | |
| |
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. |
Disaster Information |
Date of Occurrence : | |
Disaster Type : | |
| |
Please describe your personal situation in the space provided. When applying for a grant due to structural property damage you must also submit photos of the damage. Photos can be emailed to Cheri Kowal at ckowal@avma.org or mailed to the AVMF at 1931 N. Meacham, Suite 100, Schaumburg, IL 60173. |
Check ALL boxes that apply to your current situation as a result of this disaster: |
Building where employed : | Destroyed
Damaged - not functional
Damaged but functional
Not damaged
Other (please specify) |
If other, please specify : | |
Employment circumstances as a result of the disaster : | Lost job entirely
Decreased salary
Decreased clientele
Job intact - no change in salary
Benefits with salary
Other (please specify) |
If other, please specify : | |
| |
Check, if applicable (insurance coverage not mandatory for initial consideration) |
I had business insurance prior to the disaster : | |
