TMAA Resident Emergency Fund Application

Use this form to request up to $1,000 through the TMA Alliance Resident Emergency Fund, available for resident physicians and their spouses/partners who are members of TMAA. The unexpected life event that triggered your request must have occurred within the past six months. Families/individuals are limited to one request per household per year.

You can expect to receive an email from TMAA within a week indicating whether your request was approved/denied. If approved, you should receive a check within a month. If you have questions, email TMA Alliance or call Tammy Wishard at (512) 370-1470.

Name

Address

Phone

Email

Amount requested

I am requesting funds to cover costs incurred for (check one):

Bereavement (for attending a funeral of an immediate family member)
Health/dental emergency (for costs not covered by insurance, such as co-payments for root canals)
Home/car repair that affects a person’s safety or functionality of the home or car (new tires or air conditioning, for example)
Other (please explain below)

Other

In a few words, please describe why you are requesting the funds, i.e., explain your situation.

If expenses have occurred, please email a receipt to tmaalliance@texmed.org. If expenses are anticipated, you will be asked to submit a receipt after the event occurs.

If possible, please provide a testimonial TMAA could use to help raise awareness of the Resident Emergency Fund.
(By providing a quote, you give TMA permission to use this on our website or in promotional materials.)

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