Medical Education Grant Application
Eligibility Criteria
Please send any questions concerning this grant application process to the Medical Education Grant team.
Hospira will accept grant requests for accredited & non-accredited medical education programming. To learn more about Hospira's citizenship and giving initiatives, visit the "In the Community" section of www.hospira.com. All requests for support must be submitted in accordance with the Hospira Foundation guidelines via the online application process. PA doesnt handle anything other than charitable contributions. Requests for the other aspects would go elsewhere in the company.
Only accredited providers (e.g., hospitals, medical associations, medical societies and independent for-profit medical education companies) may receive medical education grants. Individual clinicians, departments of clinical service (e.g., anesthesiology, surgery, etc.) or clinical practice groups are not eligible to receive medical education grants.
A completed application for a medical education grant must be received at least 60 days prior to the:
  • Date of the event,
  • Applicant’s deadline for a Hospira response, and
  • The requested funding date for acknowledgement of Hospira’s support (e.g., brochure, logos, posters, etc.)

Approval Guidelines
  • When a medical education grant request is approved for funding, the applicant will receive a written confirmation of approval from Hospira’s Medical Education organization.
  • Only funding decisions communicated in writing by Hospira are valid.
  • Please be advised that even if an application is approved, Hospira may not be able to fund the entire original request. In this case, the applicant will be contacted and given the option to withdraw his or her application if a lesser funding is approved.

Notice
  • Applications must be for accredited or non-accredited medical education programs to be conducted in the United States. Until further notice, all grant requests for programs in other North American locations, (i.e., Canada, Mexico, and Latin America) should be sent directly to the Medical Education group at mededgrants@hospira.com.
  • Applications must be approved prior to the date of the event.
  • Funding may not be linked, directly or indirectly, to an agreement to use, prescribe, recommend or refer for Hospira products.
  • Hospira’s Grants Committee will conduct monthly application reviews.
  • All grant applications that are denied will be acknowledged in writing to the applicant.
Eligibility Questionnaire
1. Has your organization previously submitted the Eligibility Questionnaire for this specific grant request?
a.  Yes. Please enter your Eligibility Code: 
                                                                            
                                                                            
b.  No. Please continue to the next series of questions.
2.   Today’s date:     1/28/2012

3.   What is the date of your program?


4.   Our organization is an approved provider in the following accreditation categories: (Check all that apply.)




 
5.   If your organization is not the accredited provider for this grant application, please provide the name(s) of the organization(s) that will be accrediting your program
 
 
 
 

6.   This program will NOT be accredited; The program will be:



 
7.   If requested by Hospira, will you produce a copy of your accreditation-in-good-standing documentation?



8.   I/we attest that our organization is in compliance with all state, regional, and local guidelines regarding the provision of meals to healthcare professionals participating in educational events.


9.   Which one of the following therapeutic areas is the program funding being requested?Click-on the color to place your check mark in the category of your grant request.











   
Available funds key
Budget available
Limited budget
No funding available at this time.
10.   How did you learn of the online process for Hospira Medical education grants?




         His/her name (if you can recall)