I understand that no one is entitled to receive a grant, either due to virtue of their employment, their history of contributions to the Better Together Fund or because of any precedent inferred from a previous grant from the Better Together Fund. Grants will not be made before an associate has demonstrated a qualifying need.
I understand further that this application will be treated in a confidential manner by the Better Together Fund; however, non-identifying statistical information may be reported to third parties on a periodic basis.
Associates are expected to provide truthful and accurate information. In its due diligence, if the Better Together Fund discovers any information in this application to be materially untrue or fraudulent, I recognize that I may no longer expect this application to be treated confidentially and also recognize that information provided herein may be reported to Banfield Pet Hospital, BluePearl or VCA. Moreover, I authorize the Better Together Fund to notify my employer if I submit false statements, and that my employer may then subject me to disciplinary action, which may include termination.
I understand and authorize that submitting my application to the Better Together Fund will result in this information being available to Banfield Pet Hospital, BluePearl or VCA. In addition, should I qualify for a grant, I also authorize the Better Together Fund access to my payroll direct deposit information with Banfield Pet Hospital, BluePearl or VCA for the purpose of receiving a grant in a timely manner.
My signature below certifies that the information provided is true and complete, authorizes the Better Together Fund to obtain and/or verify all information necessary to process this application, and releases Medical Management International, Inc. and its affiliates, Banfield Pet Hospital, BluePearl or VCA and the Better Together Fund, from any liability associated with this application, its rejection, or its funding.
In addition, I hereby agree to provide any requested documentation supporting the information
provided.