Funding Request Form

Program Organizer / Grant Requestor

Please do not use the form below to report an adverse drug event (ADE). You are encouraged to report Adverse Drug Events (ADEs) to FDA by visiting or calling 1-800-FDA-1088.

Please enter the contact information for the program organizer.

For grants covering multiple meeting dates, please enter the first date and attach a course brochure or document containing all the meeting dates.

CE Provider / Course Sponsor (if applicable)

Please enter the contact information for the accredited CE provider for the course.

Payee Name / Teaching Hospital

Please enter the Payee Name and/or Teaching Hospital.

Enduring Material

Please enter the Enduring Material information.

Effective Dates


Your request for a CE sponsorship funding or grant will be reviewed and considered by American Regent’s Grant Committee. Review times may vary; however, typical review and response time will be 4 weeks. You may check on the status of your request by emailing us at