Start up Funding Application

Start Up Funding Application

Thank you for being a part of the 2011 SAVMA One Health Challenge: Vector-borne disease initiative. This will be a great way for SAVMA to help educate the public about the important rolevector-borne diseases play in both human and animal health.Please complete this form and submit to Claire McPhee, the SAVMA Global and Public Health Officer, to receive funding to help get your event(s) off the ground.

SCAVMA Chapter: ______

Contact Person: ______Title: ______

Address: ______

City: ______State: ______Zip: ______

Email: ______Phone: ______

Proposed Event(s): ______

Proposed Date(s) for Event(s) (Target Dates are acceptable): ______

Proposed Audience for Event(s):______

Requested Funds: ______(Maximum $400)

Proposed Budget: (A full budget is not needed at this time. Show that you have thought out the costs associated with the event(s) you are planning and that you have an idea what your start up funding will help you accomplish.)

______

______

Expectations for the use of SAVMA One Health Challenge Start Up Funding:

1. With the completion of this form, I acknowledge that SAVMA, through the generosity of its sponsors, is providing my SCAVMA chapter with funding solely for the planning and organization of One Health Challenge related events. The funds received as a result of this request will be used only for those purposes and if event plans change, un-used funding will be returned to SAVMA for use in future One Health Challenge events.

1. By accepting these funds, I agree to also help SAVMA in return by providing an account of events hosted by completing the One Health Challenge Event Summary Report after the completion of our events. This information will be used to share One Health Challenge highlights and successes with the other SCAVMA chapters through the One Health Challenge website, The Vet Gazette, etc.

I have read the expectations listed above and agree to the conditions that they explain for the use of SAVMA One Health Challenge “start up” funding. By signing below, I agree to these conditions and expectations.

Signature:______Date: ______

Printed Name: ______

If you have questions regarding this form or planning your One Health Challenge event(s), please email Claire McPhee at

Please submit completed forms to:

Claire McPhee

SAVMA Global and Public Health Officer

202 Greenwood Circle

Cary, NC 27511