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Educational Grant Request Form

Funding educational pursuits to support and advance healthcare

Male healthcare provider dressed in scrubs, facing the camera and smiling in front of a glass wall.

Medical education is critical to maintaining a healthcare system that supports the medical needs of all people. We support educational programs that promote scientific knowledge, medical advancement and the delivery of safe and effective healthcare to all people in need.

Our focus

We focus our Educational Grants on educational conferences, scientific programs, workshops and fellowship programs in the following areas: Vascular Access, Infusion Therapy, Nutrition Therapy, Regional Anesthesia and Pain Management, Renal Therapies, Interventional Cardiology, Neurosurgery, Spine Surgery, Orthopedic Surgery and Surgical Instrument Management.

If your educational program falls within our areas of focus as described above, we invite you to request an Educational Grant from B. Braun. For any questions, or if you encounter any problems, please send us an email at GrantRequests@bbraunusa.com.

Educational Grant Form

Requesting organization name *

Requesting organization address line 1 *

Requesting organization address line 2

Requesting organization city *

Requesting organization state *

Requesting organization zip code *

Requesting organization country *

Requesting organization tax ID number *

Requesting organization tax status *

Requesting Organization Type *

Requesting organization contact name *

Requesting organization contact job title *

Requesting organization contact email *

Requesting organization contact phone *

Is the contact included on this form authorized to sign the letter of agreement in case of approval of the grant? If not, please provide the name and contact information of the authorized individual. *

Educational program name *

Primary subject area *

Format of program *

Number of expected attendees *

Primary attendee type *

Is the program accredited? *

Start date *

Location

Location *

Requested amount (Do not use any symbols in this field, only numbers. I.e. do not use $ or ,) *

Describe the educational program in more detail and how a grant from B. Braun would be used. *

Are you requesting grants from other medical device, pharma or life sciences companies besides B. Braun? If so, please identify these companies by name. *

Are you requesting a loan or donation of B. Braun products, or do you need other support from B. Braun, in addition to a grant? If so, please describe in detail. *

Will there be any recognition or other benefits to B. Braun for providing an educational grant? *

If you receive a grant from B. Braun, will you agree to return any unused portion of the grant to B. Braun at the end of the program? *

The following supporting documentation must be attached and submitted with the Educational Grant Request Form:

1. Description of educational program *