Request assistance

Use this form to nominate a veterinary professional — veterinarian, technician, assistant, client care team member, kennel team member, or practice manager — who is facing hardship. You may nominate someone else or yourself. All information is kept confidential.

About you (the nominator)

Your name *

Your email *

Your phone (optional)

Your relationship to the nominee (optional)

About the nominee

Nominee's name *

Their role in the veterinary field (optional)

Nominee's email (optional)

Nominee's phone (optional)

Where should the award be sent if approved? *

Mailing address, clinic address, or the best way to deliver support (for example, a gift card by email or a bill paid directly).

The need

Briefly explain the need *

What is happening, and how would support help right now?

Which of these apply? (check all that apply)Illness or medical crisisJob loss or reduced hoursChildren or dependents in the householdRisk of hunger / food insecurityRisk of housing insecurity

Other circumstances (optional)

Any other relevant information (optional)

Keep this nomination anonymous — please do not share my name with the nominee.I understand that submitting a nomination is not an automatic approval, and that awards depend on review and available funds. *