Professional Medical Education Grant Application

Professional Medical Education Grants provide funding for independent medical educational programs for health care professionals, including congresses, conferences, symposiums, or courses, with or without labs, that are sponsored by professional medical associations, societies, or continuing education providers and academic institution labs. This includes support requested for cadaveric labs intended to educate fellows or residents at an academic institution.

Acumed does not provide grants to individual health care professionals (HCPs) or to HCPs in training and does not provide grants that are earmarked for the benefit of individual HCPs or HCPs in training.  Accordingly, Acumed will not consider grant requests earmarked for individual HCPs or HCPs in training.

Submission deadline: To be considered, the completed application, including all required supporting documentation, must be received at least 60 days before the scheduled date of the event, activity, or program. If you have any questions, please contact grants@acumed.net.

Contact information

Applicant organization information

Grant Request

Event Details

Required Attachments

The following file formats are allowed: rtf, odf, pdf, doc, docx. Maximum file size per file is 8 MB.
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For Applicant Organizations located outside of the United States that do not have a W-9 or 501(c)(3) tax-exempt IRS Determination Letter, please provide a W-8BEN-E which can be downloaded from the United States Department of Treasury Internal Revenue Service website.
Click or drag a file to this area to upload.
Letter of Request on the Applicant Organization’s letterhead outlining the activity, the specific amount being requested, names of faculty members who will participate, number of fellows/residents/health care professionals affected, general background on the educational activity, and be signed by an individual with the requisite authority to submit the grant application on behalf of the Applicant Organization.
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Agenda for program, topics for discussion, and schedule (must include date, times, topics, faculty, etc.)
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Purposed itemized budgetary breakdown of how the funds will be utilized within the overall program. For grant requests related to travel, lodging or registration fees, supporting documentation such as screen shots of estimates and/or confirmation materials showing pricing for airfare, lodging, and course registration fees are required.

Optional Attachments

Optional Additional Attachment: Attendee invitation, CME accreditation certificate, program brochure, or other collateral marketing materials. Maximum file size per file is 8 MB.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.

Certifications

This Certification is intended to require the Applicant Organization, Acumed, and their personnel to comply with the laws and regulations applicable to relationships between donors and requestors of grant funding, including but not limited to the federal Anti-Kickback Statute (42 U.S.C. §1320a-7b(b)), state anti-kickback laws and regulations, and the Foreign Corrupt Practices Act of 1977 (15 U.S.C. §78dd-1, et seq.). Acumed reserves the right to modify the requirements of this Certification as Acumed deems appropriate to ensure compliance with state and federal laws and regulations.
(Individual submitting this Grant Application)
I, the Submitter of this Grant Application, certify that to the best of my knowledge all of the following statements are true with respect to the submission of this Grant Application:

  1. I have the requisite authority to submit this Grant Application on behalf of the Applicant Organization.
  2. All information provided in this Grant Application and its attachments is true and accurate as of the date of this Grant Application, and I am unaware of any information or other circumstance that is likely to render any such information false or erroneous. I will promptly notify Acumed in the event that any information provided in this Grant Application and its attachments becomes false or erroneous.
  3. The submission of this Grant Application does not violate the Applicant Organization’s Code of Ethics, Conflict of Interest Policy, or any other policy of the Applicant Organization and does not violate any law or regulation to which the Applicant Organization is subject.
  4. The Applicant Organization, its personnel, and I have not, implicitly or explicitly, solicited the requested grant in exchange for an agreement to purchase, use, order, or recommend Acumed products or as a reward for any prior purchase, use, order, or recommendation of Acumed products. The Applicant Organization, its personnel, and I acknowledge and agree that Acumed’s decision of whether to approve or deny this Grant request is wholly unrelated to any prior or future purchase, use, order, or recommendation of Acumed products. I further acknowledge that any offer to purchase, use, order, or recommend Acumed products in connection with this Grant Application will result in the automatic denial of the Grant request.
  5. No Acumed representative implicitly or explicitly offered a grant to the Applicant Organization, its personnel, or to me to encourage or to reward the prior or future prescription, purchase, use, order, or recommendation of any Acumed product. I understand and acknowledge that any decision to approve a Grant request is determined independently, without regard to the volume or dollar value of any business that may have been or may be potentially generated by the Applicant Organization.
  6. The Applicant Organization, its personnel, and I are not a person (or persons) or organization: (a) excluded from a federal health care program as outlined in Sections 1128 and 1156 of the Social Security Act; (b) debarred by the FDA under 21 U.S.C. 335a; (c) otherwise excluded, suspended, or debarred from contracting with the federal government or participating in a federal health care program; or (d) convicted of or under investigation for a health care-related criminal offense, including any violation described in 42 U.S.C. §1320a-7(a).
  7. The Applicant Organization, its personnel, and I shall comply fully with the U.S. Foreign Corrupt Practices Act (15 U.S.C. §§ 78dd-l et seq.), and any similar laws of any jurisdiction that are applicable to them, including those of the Kingdom of Belgium, the European Union and any other countries in which the Applicant Organization operates, and all countries otherwise having jurisdiction over the Applicant Organization or the educational activity that the grant requested hereunder is to support (collectively, “Anti-Corruption Laws”).
  8. The Applicant Organization, its personnel, and I represent and warrant that in the event the educational activity that the grant requested hereunder is to support is conducted in a foreign country, the award of the grant, the use of grant funds, and the conduct of the educational activity that the grant requested hereunder is to support will not violate any local laws, regulations or ordinances.
  9. The submission of this Grant Application does not guarantee approval of this Grant Application, and if approved by Acumed, Acumed may approve funding at an amount less than what has been requested.
  10. The Applicant Organization shall at all times maintain complete control over the clinical and educational aspects of the educational activity that the grant requested hereunder is to support that is the subject matter of this Grant Application, including but not limited to the selection of individuals to participate in the program, the academic curriculum, and the standards of the program.
  11. If this Grant Application is approved, the Applicant Organization will be required to represent and warrant, in a separate writing, that: (a) the receipt of grant funding will not affect its or its personnel’s’ professional judgment; (b) it will assist Acumed in complying with its reporting duties required by the Physician Payment Sunshine Act and its implementing regulations (42 C.F.R. § 403.900 et seq) as an applicable manufacturer; and (c) Acumed shall have the right to audit the use of grant funds, and the Applicant Organization will provide Acumed with reasonable access to copies of receipts related to the expenditure of grant funding.