Grant Request Application

Topics: Jonathan Frakes, Program, Peter Milligan Pages: 10 (1193 words) Published: January 30, 2011
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GRANT REQUEST APPLICATION

Overview:

Abbott Medical Optics Inc. (AMO) supports educational activities that are aligned with AMO therapeutic areas of interest by funding grants for medical education programs that are attended by health care professionals (HCPs) and their affiliates. Once submitted, AMO will review your completed Grant Request Application on the basis of: ▪ Alignment with AMO’s current educational grant strategy, ▪ Educational merit,

▪ Audience scope,
▪ Compliance with legal, ethical and professional obligations, and ▪ Fiscal responsibility.

Note: There can be no assurance that your completed Grant Request Application will be approved or that, if approved, funding will be provided in the amount requested.

Please ensure that your program/event takes place no earlier than 60 days from today to ensure that there is adequate time for your request to be reviewed and processed.

You will need to provide the following documents/information: ▪ Program Details (see attached p.3)
▪ W-9 (must be completed, signed and dated within 12 months from the date of the program and submitted with your application) ▪ Detailed Budget (see attached p. 6)
▪ Detailed Agenda
▪ Copy of the certificate of accreditation for accredited programs (if any), together with a copy of the accrediting body’s standards and guidelines ▪ Letter of Request must:
o Be on company letterhead
o Include a request to Abbott for the exact dollar amount o Briefly describe the program
o Briefly give some background information of your institution

Send your completed Grant Request Application to:

Email address: grant.coordinator@amo.abbott.com

Note:This Grant Request Application must be completed for all educational program funding requests, both those where funding is provided to an independent third party sponsor having exclusive control over program content, faculty, educational methods, venue, etc., and those where AMO may have some or complete control over such aspect or aspects of the educational program. General Information

|Requesting Organization | | |Organization’s Legal Name: |Congresses Management Ltd | |Street Address: |53 Rothschild Boulevard, Tel Aviv, Israel, P.O box 68 | |City, State and Zip: |Tel Aviv, Israel | |Contact Name: |Anat Weiss | |Contact Email Address: |anat@comtecmed.com | |Contact Phone Number: |+972-3-5666166 |

|Program Overview | | |Program Type: |Sponsored by Independent* 3rd Party: | |* “Independent” 3rd party sponsor must provide|CME CE | |the program and maintain full responsibility |Non-accredited educational meeting | |for, and control over, the selection of | | |program content, faculty, educational methods,| | |materials and venue....
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