Cancel

OK

You have successfully logged out.

Educational Grant Request Form

Funding educational pursuits to support and advance healthcare

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 *

Select One

Select One
501 (c) (3) Corporation
501 (c) (6) Corporation
Other Non-Profit Organization
For Profit Organization

Requesting Organization Type *

Select One

Select One
Accredited Medical Education Provider
Hospital, Community Health Center or other type of Healthcare Organization
Medical, Nursing, Pharmacy or other Healthcare Professional Association
University
Other

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 *

Select One

Select One
Vascular Access
Infusion Therapy
Nutrition Therapy
Regional Anesthesia & Pain Management
Renal Therapies
Interventional Cardiology
Neurosurgery
Spine Surgery
Orthopedic Surgery
Surgical Instrument Management
Other

Format of program *

Select One

Select One
Educational Conference
Scientific Program
Workshop
Fellowship Program
Other

Number of expected attendees *

Select One

Select One
Less than 10
11-50
51-100
101-200
Greater than 200

Primary attendee type *

Select One

Select One
Nurses
Medical Students
Medical Fellows
Physicians
Scientists
Other

Is the program accredited? *

Start date *

Location (Please pick the state the event will be held in) *

UT

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 *

cloud_upload Drag and Drop files, or click to browse

2. Evidence of accreditation (if applicable)

cloud_upload Drag and Drop files, or click to browse

3. Educational program agenda *

cloud_upload Drag and Drop files, or click to browse

4. IRS form W9 *

cloud_upload Drag and Drop files, or click to browse

5. Any necessary documentation B. Braun will be asked to sign

cloud_upload Drag and Drop files, or click to browse

By submitting this request, I acknowledge the B. Braun will require a signed agreement in the event my request is approved and before providing the approved support.