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
- Provider Accreditation Certification or Status (e.g. ACCME) (if applicable)
- Detailed Line Item Activity Budget
- W-9 Form (i.e. Must be signed and dated within the last year) (US organizations only)
- Activity background information (e.g. Brochure, Announcement, Flyer)
- Grant Letter of Request (LOR)
Grant Letter of Request must include the following:
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- 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
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