2022 SCVMA and Animal Health Foundation Angel Fund Grant Owner/Pet Application Form 

Please fill out this page completely for consideration for Angel Fund eligibility
APPLICATION REQUIREMENTS

This application  needs to be completed and submitted once.

By filling out the information below, this hospital agrees to the following:
*Our hospital has at least one current SCVMA member veterinarian
*We agree to share information about the case and the client including a high resolution photograph of the pet and owner
*We agree to screen the client for needs PRIOR to submitting the application
*We understand there is a limited amount of funding and we are only eligible for $1000.00 per year.
*We agree to match the Angel Fund Grant amount up to $500.00.
*We understand that any activity that might be considered fraudulent will be reported to the appropriate authorities.
*We understand NOT everybody in need can be assisted.
*We agree to help further the AHF-SCVMA Angel Fund Grant by placing a collection jar in our lobby if asked to do so.
*We agree that our practice name and doctor's names maybe used in Press Releases created to promote the Angel Fund Grant, Animal Health Foundation, and SCVMA
*We agree to ensure the client understands they must provide an interview about their pet and their experience to promote the Angel Fund and encourage veterinarians to use the fund to assist pets in need.

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* 1. PART A: TO BE COMPLETED BY OWNER

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* 2. I certify that all of the above have been answered truthfully and accurately.

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* 3. Part B: TO BE COMPLETED BY VETERINARY HOSPITAL REPRESENTATIVE

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* 4. To the best of my knowledge, the information below is TRUE (DVM/Manager initial in box):

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* 5. I certify that all of the above have been answered truthfully and accurately.

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