Disaster Grant Application: Emergency Expenses

Disaster Grant Application

Reimbursement of Emergency Expenses
PURPOSE

Ensure the emergency medical care of animal victims of disaster.

AWARDS

Up to $2,000* can be issued per grantee for out-of-pocket expenses, which are defined as the actual cost of medical supplies purchased directly from a vendor. Modest boarding costs may be covered. Professional/staff time, overhead costs, equipment usage fees and taxes are not reimbursable.
*Grant requests for funds above $2,000 for medical expenses are reviewed on a case by case basis.

VETERINARIAN ELIGIBILITY
- Must be a licensed veterinarian and be a TVMA Member in good standing
- Must have provided for the medical care of animal vistims of the disaster listed on the application. Preference is given to TVMA members.
APPLICATION PROCEDURE

Applicants can request up to $2,000 in grant funds. Checks will be payable to the person/entity named in your application.

Note that TVMF must be given permission to use the funded project for future
recruitment of funds and receive acknowledgement for funding.

DEADLINE

Applications must be received no later than nine (9) months following the disaster.

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. Detailed invoice/account of medical expenses
3. Photos of treated animals.
GRANT AWARDS

Notification of grant awards are made directly by the TVMF COO and/or appointed designee within five business days (Monday through Friday, excluding major holidays) of receiving the application.

QUESTIONS

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

Disaster Grant Application

Reimbursement of Emergency Expenses
Veterinarian Information
Date*

MonthDayYear
Date
Veterinarian*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Check the one box that applies best to the situation:*

The clinic has been damaged but is operational and providing assistance to affected animalsThe clinic has been damaged but a temporary facility has been established and is providing assistance to affected animalsThe clinic was not damaged and is providing assistance to affected animalsThe clinic is outside the disaster area but providing assistance to the animalsThe clinic is mobile and providing assistance to affected animals in the disaster stricken areasOther
Upload clinic W-9:*

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Disaster Grant Application

Reimbursement of Emergency Expenses
Grant Request Narrative
Please provide a short narrative explaining your involvement in providing care to animal victims of the disaster(s).*
Approximate Number of Animals Served:*

Disaster Grant Application

Reimbursement of Emergency Expenses
Upload detailed invoice/account of medical expenses used to treat animals.*

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Grants are subject to availability of funds and may not exceed $2,000 per application. Grant Amount Requested:*
Upload any additional supporting documentation here:

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Disaster Grant Application

Reimbursement of Emergency Expenses
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:

Disaster Grant Application

Disaster Grant Application

Veterinarian Information

Disaster Grant Application

Grant Request Narrative

Disaster Grant Application

Disaster Grant Application

Grant Terms and Consent