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 www.fda.gov/medwatch 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.

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

Submission

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 argrantapplication@americanregent.com.