Applying for NYSVMS Foundation Funds

Applying for NYSVMS Foundation Funds

Please complete the following form to apply for funding.
Which describes you best*

I am an NYSVMS member veterinarianI work for an NYSVMS member veterinarian and am applying on their behalfI am a pet owner seeking funds
This application form is for Veterinarians and their employees only.

Pet owners should contact their NYSVMS veterinarian and ask them to apply for funding.

WE DO NOT ACCEPT APPLICATIONS FROM PET OWNERS
Before proceeding please check funds available for your region. Use the regional dropdown below to find your region.
Your Region*
Currently only the regions in the dropdown have funds available.
Today's Date

MonthDayYear
Member Veterinarian's Name*

First NameLast Name
Name of person completing form if not member

First NameLast Name
Your contact email*
example@example.com
Your practice name*
Client Name*

First NameLast Name
Pet Name*
Amount applied for - maximum $2000*
Owner*

Owner has a financial barrier to obtaining the necessary care
Animal must be privately owned*

Animal is not owned or under the care of a shelter or rescue, and is not for breeding or commercial purposes
Condition is a fixable problem*

The application is for NONE of the following: Private cremation, chronic care, multiple procedures to treat an issue, chemotherapy, cosmetic procedures, routine preventative care - unless directly related to an acute welfare issue (eg: spay for pyometra) or otherwise necessary due to public health considerations (eg: rabies vaccination)
All Criteria are Met
Not all criteria have been met. Sorry, but we cannot accept your application
I will ask the owner to sign a form giving permission for NYSVMS to share their story and pictures of their pet.*

YesI prefer not to ask this client
Brief description of the animal's condition and treatment provided.*
This is for our records and will not be used to determine eligibility
Brief summary of client circumstances and why support is needed.*
This is for our records and will be used to document eligibility.
Upload the invoice

Cancelof
I/we affirm that this case meets all the criteria specified above and that I/we believe this is a worthy and appropriate use of the funds raised by the Foundation.*

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