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Key Tag Program
TB Vets Grant Application
Name of Organization / Foundation
Registered Charity No.
Newfoundland and Labrador
Prince Edward Island
Name of Hospital / Health Centre where equipment will be used
Provide a brief overview of your hospital or health centre and the patients you serve.
Describe or list your annual fundraising events or initiatives.
Name/Model and Description of how the equipment will be used
Cost of respiratory equipment to be acquired
Explain why the acquisition of this respiratory equipment is a priority.
Describe how this respiratory equipment will benefit patients and approximately how many patients annually.
Explain if this is acquisition being cost-shared with your foundation of any other organization.
If your TB Vets grant is approved, how will you publicize this contribution:
Attach a quote of the proposed acquisition:
Provide a photo of the proposed acquisition:
Grant Application Agreement
Within three months of receiving the grant, you agree to provide an authorized patient and health professional testimonial with photographs for use by TB Vets. Form responses may also be used and/or quoted for marketing purposes.
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