Checklist

Grant Request Checklist

To complete the Smith & Nephew Biotherapeutic Grant Online Application you will need the following information and documentation.

Contact Information
  • Name.
  • Title.
  • Phone.
  • Fax (optional).
  • Email.
Grant Requester Information

If Grant Requester is a Health Care Organization:

  • Name
  • Health Industry Number (Optional)
  • Employer Identification Number (EIN) – applicable to US ONLY
  • Address
  • Phone
  • Fax (optional)
Activity Information
  • Title
  • Objective
  • Start Date
  • End Date
  • Location
  • Product
  • Disease State (if applicable)
  • Therapeutic Options, Conditions, Procedures or Scope
  • Requested Amount (if requesting in-kind support and amount is unknown, please enter $1)
Documents
  1. Provider Accreditation Certification or Status (e.g. ACCME) (if applicable)
  2. Detailed Line Item Activity Budget
  3.  W-9 Form (i.e. Must be signed and dated within the last year) (US organizations only)
  4. Activity background information (e.g. Brochure, Announcement, Flyer)
  5. Grant Letter of Request (LOR)
    Grant Letter of Request must include the following:
      • Must be copied onto Grant Requestor letterhead
      • Must be signed
      • Describes learning objectives
      • Describes activity or program details
      • Describes how funding or in-kind support will be used
      • Includes activity date and venue location
      • Includes whether activity or program is accredited or non-accredited