Grant For an Investigator-Initiated Study Form

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B. Braun and its U.S. affiliates support researchers, physicians and institutions who are interested in conducting their own research. The investigator and/or institution assume responsibility for all aspects of a study, and grants are awarded based on medical or scientific merit, unmet medical need, study feasibility, and availability of funds. B. Braun and its U.S. affiliates consider requests to support Investigator-Initiated Studies in the therapeutic areas that are aligned with our areas of focus, in the form of funding and/or product donation.

The following documentation is required:

Fully executed IIR agreement between the requesting organization and B. Braun or a U.S. affiliate company
IRB approval

Requesting organizations and B. Braun and its U.S. affiliates acknowledge and agree that any grants shall not obligate the organization to purchase, use or recommend the use of any products. All grant requests need to be received at least three (3) months before the grant is required. Please complete this form and submit it for processing; requests with missing information or supporting documentation will not be considered.

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 Type

Principal Investigator Name

Principal Investigator Job Title

Principal Investigator Email

Principal Investigator Phone

Study Protocol Title (please attach protocol)

Study Description

Requested Dollar Amount (N/A if requesting a Product Donation only)

Are you requesting a product donation to support the Study? If so, please identify the product name (or SKU), description, and quantity of the product needed for the Study.

Describe how the Grant and/or Product Donation will be used for the Study.

Product shipping information (may not be to a personal address) if products are requested and if different than Organization or Principal investigator information provided above:

Organization Name

Organization Address

Contact Name

Contact Email

Contact Phone

Study Protocol

Study Budget (if requesting money)

IRS Form W9

If requesting product a complete list of the products requested using the Product Name (or SKU) and quantity of each. This information can be found on B. Braun’s website

Requests and Documentation may also be

Emailed to:
GrantRequests@bbraunusa.com

Mailed to:
c/o B. Braun Medical Inc.
Attention: Corporate Compliance
824 Twelfth Avenue
Bethlehem PA, 18018

Compliance is what gives us the right to do business. At B. Braun, each of our employees is responsible for doing the right thing for the Company and for themselves. Acting in compliance allows us to continue to make a true difference for our customers and the patients they serve.

Product shipping information (may not be to a personal address) if products are requested and if different than Organization or Principal investigator information provided above:

Your request could not be submitted. Please try again.

Requests and Documentation may also be

Compliance is what gives us the right to do business. At B. Braun, each of our employees is responsible for doing the right thing for the Company and for themselves. Acting in compliance allows us to continue to make a true difference for our customers and the patients they serve.