Rusk Veterinary Assistance Grant Guidelines and Application

Rusk Veterinary Assistance Grant Guidelines
PURPOSE

Rusk Veterinary Assistance Grants provide funds to supplement a veterinarian’s charitable care for animals of low-income families or for families that have an undue financial burden due to extenuating circumstances. A primary goal of the Rusk Veterinary Assistance Grant is to keep the human-animal bond intact by resolving medical issues that will restore the animal’s health.

The Rusk Veterinary Assistance Grants is a last-resort financial option intended to support a one-time surgical or medical intervention for an animal with a good to excellent prognosis. Without such emergency funding, an otherwise treatable animal might be unnecessarily euthanized, relinquished, and/or endure excessive suffering.

VETERINARIAN ELIGIBILITY

To be eligible for a Rusk Veterinary Assistance Grant, the veterinarian must:
- Must be a licensed veterinarian and be a TVMA Member in good standing
- Practice must be located in the state of Texas
- A reasonable effort must be made to discount services in Rusk Veterinary Assistance Grant cases
- Provide the patient’s medical records
CLIENT ELIGIBILITY

A case selected by the applying veterinary practice must meet the following criteria:
- The client must reside in the state of Texas
- The client demonstrates financial need and can make a financial
  contribution toward the cost of the animal’s care
- There must be evidence of a significant and compelling human-animal
  bond between the client and patient.
- The client is willing and able to provide recommended follow-up care
- The client must submit the pet owner questionnaire found here
- Staff members of the Texas Veterinary Medical Association and Texas
  Veterinary Medical Foundation and Texas Veterinary Medical Foundation Board of Trustees are ineligible for a Rusk Veterinary Assistance Grant.
GRANT FUNDING
- Is subject to available funding
- Is limited to $2,000 per veterinary practice per calendar year; may be approved up to $1,000 per case
- Is limited to one grant per household unless a special exemption is provided by the Executive Director and/or the appointed designee
- Must be used for a one-time surgical or medical intervention that will improve the prognosis and well-being of the patient, and is not meant for treating chronic conditions
- Cannot be used for a treatment that was rendered more than two weeks prior to submission of application
- May not be used for spay/neuter procedures unless spay/neuter is essential to the continued health of the animal
- Will take the animal’s age and other underlying issues under consideration in the determination of the Rusk Veterinary Grant award.
Examples of Appropriate Cases with Otherwise Healthy and Stable Animals:
- Stage 1 heartworm treatment
- Humane euthanasia
- Cystotomy for Urolith
- Abscessed tooth or acute dental issue
- Uncomplicated pneumothorax
- Parvovirus (stable patient with good to excellent prognosis)
- Simple fracture repair with excellent prognosis or amputation
- Gastric Dilatation/Volvulus (GDV) or foreign body
Examples of Inappropriate Cases:
- Chronic renal faliure
- Chemotherapy or amputation due to osteosarcoma or complex fracture repair
- Recurring uroliths or urethral obstruction
- Hemoabdomen due to cancer
- Diabetic ketoacidosis
- Oral Cancer
- Congestive heart failure
- Private cremation
APPLICATION REVIEW

The TVMF Grants Committee wil lreview all applications. The applying veterinarian(s) must be reachable during the review process in the event of additional questions.

REQUIRED ATTACHMENTS
1. Clinic W-9: https://www.irs.gov/pub/irs-pdf/fw9.pdf
2. Treatment Plan and itemized estimate for services
3. Pet owner questionniare completed by your client: https://form.jotform.com/212006632635043 .
GRANT AWARDS

Notification of grant awards are made directly by the TVMF Director and/or appointed designee within five business days (Monday through Friday, excluding major holidays) of receiving the application. 24 to 48-hour notification applies only to applicants that are in a life-threatening situation.

POST APPROVAL
- Patient medical records must be submitted to TVMF from date of original visit and include rechecks as related to the approved treatment.
- The veterinary clinic will collect the signed release and consent form from the client and submit it to TVMF
- Grant payments are paid directly to the veterinary clinic upon TVMF’s receipt of a final invoice and the signed release and consent form. Payment will NOT be made directly to the client.
- Payment will not be made to other providers beyond the veterinary clinic associated with the grant award.
QUESTIONS

Contact Leah Ann Tibbitts, COO, at 512-452-4224 or Ltibbitts@tvma.org.

Rusk Veterinary Assistance Grant Application
Veterinarian Information
Date *

Month Day Year
Date
Veterinarian *

First Name Last Name
TVMA Member # *
Clinic Name *
Clinic Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Upload clinic W-9: *

Cancel of

Rusk Veterinary Assistance Grant Application
Client Information
Client Name *

First Name Last Name
Patient Name *
Client Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Client Phone Number *
Please enter a valid phone number.
Client Email *
example@example.com
Patient Species *

Canine Feline Equine Bovine Other
Patient Age *
Patient Breed *
Patient Sex *
Is the client an established client and/or has been to clinic in the last 12 months? *

Yes No
Please describe the client's relationship with animal: *
Why are you advocating on your client's behalf? Why do you feel your client is a good candidate for a Rusk Veterinary Assistance Grant? *
Is the client a resident of Texas? *

Yes No

Rusk Veterinary Assistance Grant Application
Diagnosis and Treatment Plan Financial Information
Provide a contextual description of the animal’s overall health in addition to your diagnosis, treatment plan, and prognosis: *
Estimated total cost of care for the animal: *
Upload itemized financial estimate and treatment plan. Please include any discounts that are being applied to estimate. *

Cancel of
A reasonable effort must be made to discount services to qualify for a Rusk Veterinary Assistance Grant. Value of discounts provided by veterinarian: *
No matter the grant ask amount, each client must contribute to the cost of the animal’s care. Financial contribution of the animal owner: *
Total dollar amount of client's contribution
Grants are subject to availability of funds and may not exceed $1,000 per case. Grant Amount Requested: *
Upload any additional supporting documentation here:

Cancel of

Rusk Veterinary Assistance Grant Application
Grant Terms and Consent
Electronic Signature Agreement:

By clicking the submit button, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application. By selecting "I Accept" you consent to be legally bound by this Application's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide the Texas Veterinary Medical Foundation (TVMF) or in accessing or making any transaction regarding any Application, agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and TVMF. You also represent that you are authorized to submit this Application on behalf of the Applicant.
E-Signature *
Should be Empty:

Rusk Veterinary Assistance Grant Guidelines

Rusk Veterinary Assistance Grant Application

Veterinarian Information

Rusk Veterinary Assistance Grant Application

Client Information

Rusk Veterinary Assistance Grant Application

Diagnosis and Treatment Plan Financial Information

Rusk Veterinary Assistance Grant Application

Grant Terms and Consent