Grant Application - NH Veterinary Center for Wildlife

NH VETERINARY CENTER FOR WILDLIFE GRANT APPLICATION

Applicant Information

Your Name

First

Last

Organization (if applicable)

Address

Address Line 1

City

State

Zip Code

Phone

License/Permit Number and Issuance Date

Eligibility

Select your eligibility status

Project Details

Grant Request Title

Requested Grant Amount

Brief Grant Request Summary (100 words max)

Budget Breakdown

(This total must equal the Requested Grant Amount)

Item/Service #1

Cost Item #1

Description Item #1

Item/Service #2

Cost Item #2

Description Item #2

Item/Service #3

Cost Item #3

Description Item #3

Link to Equipment Web Page

If you are requesting a grant for equipment, please provide a link/URL to the web page that displays it.

Item (if Cost

Statement of Need

Tell us why you think you should receive this grant and how it will benefit New Hampshire’s wildlife. Please include your monthly wildlife caseload by species for each of the past 6 months and anticipated frequency of equipment use.

Statement of Support

Drag & Drop Files, Choose Files to Upload

If you are an existing licensed wildlife rehabilitator or prospective licensed wildlife rehabilitator, please provide your veterinarian of record's contact information and the tenure and extent of your relationship. In addition, please have your veterinarian forward a statement of support directly to us at info@nhwildlifecare.org with your name in the subject line. Alternatively, you can let them know that we will contact them directly for their statement of support.