1. Requestor Information: Please provide background information on your company and contact information. If the institution is not a registered 501(c) entity, please state whether a doctor or other healthcare professional has a leadership role in the institution’s management or has a direct or indirect ownership interest of over 5% in the institution.
2. Target Audience: Please describe the target audience to be targeted.
3. Purpose of Grant: Please describe the program for which you are seeking charitable donation? Describe how the funds or products will be used, including specific details. Please provide supporting information to clearly document the need of the target audience that will be addressed through your program.
4. Product or Funding Request: How much funding are you seeking from BioTissue? What product and quantity are you seeking from BioTissue? What date is the delivery of the award requested?
5. Organization W9
BioTissue is committed to ensuring the independence and integrity of the medical education programs that we fund. Funding from BioTissue is subject to Sunshine Act reporting. Please send questions about BioTissue’s funding process in writing to: [email protected].