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Charitable Donation Request Form

Supporting patients in need and advancing our local communities

The stronger our communities, the stronger our company. We understand the true meaning of corporate citizenship and are devoted to advancing the health, diversity and inclusion of our communities.

Our focus

We focus our Charitable Donations on communities where our manufacturing facilities and offices are located. We prioritize non-profit organizations and programs in the following areas:

Health Equity – Expanding medical care for underserved patient populations and addressing social determinants of health

Diversity and Inclusion – Promoting education, awareness and action to advance diversity and inclusion in our communities, and supporting and partnering with diverse and economically disadvantaged populations

Educational Advancement – Advancing STEM education and manufacturing skills

Arts and Culture – Supporting community-based arts and cultural programs

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

Charitable Donation Request Form

Requesting organization name *

Requesting organization address line 1 *

Requesting organization address line 2

Requesting organization city *

Requesting organization state *

Requesting organization zip *

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 *

Charitable program name (if applicable) *

Type of charitable cause *

Number of people benefiting from the charitable event/program *

Event date *

In which state is the community that will benefit *

City of the community that will benefit *

Event description *

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

Describe how the funds will be used *

Will B. Braun employees have the opportunity to participate in the charitable event or program? If so, please explain. *

Will you require any documentation from B. Braun (for example, a certificate of insurance, donation agreement, etc.) if your request is approved? If so, please explain. *

The following supporting documentation must be attached and submitted with the Charitable Donation Request Form:

1. Non-profit designation letter *