Grants - Medical Education

MEDICAL EDUCATION GRANTS

Tris Pharma is committed to supporting educational endeavors that are consistent with our mission to improve health outcomes. Tris Pharma is also committed to compliance with all applicable laws and regulations, as well as our Code of Ethics and Sales and Marketing Compliance Policy. Please note that the Medical Education Grant/Support Procedure prohibits Tris Pharma sales personnel from participating in the medical education grant process.

Tris Pharma Provides Medical Education Grants for the Following Categories:

Continuing Medical Education programs presented by accredited providers
Education programs for Health Care Professionals
Medical Society Sponsored programs

Guidelines for Medical Education Grants:

Educational focus
Balance
Broad Audience

The criteria governing the award of Tris Pharma Medical’s medical education grants are intended to ensure that support for activities is never tied to the past or future use of our products.

For more information, please access the Tris Pharma Medical Education Grant Request Form:

Online Medical Education Grant Form: United States
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Grants- Medical Education

"*" indicates required fields

TRIS PHARMA MEDICAL EDUCATION GRANT REQUEST FORM

Tris Pharma is committed to supporting genuine medical education that meets defined clinical educational needs. Tris Pharma medical education grants are governed by the following guidelines:

Tris Pharma provides cash or in-kind support for accredited medical educational programs or events which promote genuine scientific oreducational discourse.
Tris Pharma does not provide support for speaker honoraria, recreation, entertainment, or food and beverages in connection with medical educational programs or events.
Grants are provided to program or event sponsors, or training institutions. Grants are not provided to individuals.
Tris Pharma does not control or provide input into educational program content, faculty, or attendees.
Grants are not provided as an inducement or quid pro quo for purchases of Tris Pharma products.
All grants are provided in accordance with the AdvaMed Code of Ethics on Interactions with Health Care Professionals or other applicable ethical guidelines, and applicable law.

Grant requests should be submitted at least 12 weeks prior to the program/event start date.

PERSON RESPONSIBLE FOR GRANT REQUEST

Salutation

First Name*

Last Name*

Position/Title*

Primary Organization/Facility*

Health System Affiliation (if applicable)

Street Address*

City*

State/Province*

Postal Code*

Mailing/Shipping Address (if different from Street Address)

Street Address

City

State/Province

Postal Code

Phone*

Fax

Email Address*

REQUESTING ORGANIZATION INFORMATION

Full legal name of requesting Organization/Facility/Accredited Provider*

Health System Affiliation (if applicable)

Street Address*

City*

State/Province*

Postal Code*

Tax ID Number*

APPROVED GRANT RECIPIENT

If different than Person Responsible for Grant Request, approved grant should be sent to:

Salutation

First Name

Last Name

Position/Title

Primary Organization/Facility

Health System Affiliation (if applicable)

Street Address

City

State/Province

Postal Code

Mailing/Shipping Address (if different from Street Address)

Street Address

City

State/Province

Postal Code

Phone

Fax

Email Address

GRANT REQUEST DETAILS

Request Type (select all that apply)*

Monetary

Technician

Simulator(s)

Product/In-Kind Support

Are you Requesting Tris Pharma as the sole supporter of this activity?*

Yes

If no, please specify additional sources of support:

NEEDS ASSESSMENT

All educational grant requests must include a needs assessment that clearly defines the unmet educational need or gap the activity will address. Please note that the Learning Objectives are not the same as the Needs Assessment; Learning Objectives should support the educational need identified by the Needs Assessment.

What is the identified educational void or gap being addressed through the proposed education?
Indicate whether the education will address a knowledge gap or a practice gap
Describe the specific knowledge gap or practice gap to be addressed
Why has the intended audience been selected as participants for the proposed education?

What are your sources to substantiate your statement that this is an unmet educational need? As available, please provide applicable examples of acceptable sources for a Needs Assessment which may include the following:

Expert

Expert data may be derived from sources including:

Literature Searches of peer-reviewed medical literature

Advisory Board Feedback (independent of Tris Pharma)

Expert practitioner / thought-leader interactions

Market Research on Professional Needs

Participant data may be derived from potential sources including:

Focus Panels

Medical education feedback

Survey(s) of the proposed target audience

Observed Data

Observed data may be derived from a number of sources, including:

National and regional data from national research institutes and healthcare professional organizations (CDC, NIH, other)

List the Learning Objectives for the program/event that will help close the gap(s) identified in the Needs Assessment*

Within sixty (60) days of the end of the program/event, provider must submit to Tris Pharma an evaluation whether and how the program/event met the identified educational needs.*

By checking this box, I acknowledge the educational needs evaluation period.

PROGRAM/EVENT DETAILS

Start Date

End Date

Location of the Program/Event

Name and description of program/event*

Description of the objectives of the program/event*

Target audience (Healthcare Provider discipline)*

Family Medicine

Pediatrics

Psychology

Psychiatrist (All Ages)

Child Adolescent Psychiatry

Adult Psychiatry

Development/Behavioral Pediatrics

Neurology (All Ages)

Non-Psychology Therapy/Coaching

Pharmacy

Specialty/Other

Projected number of Attendees*

Presentation Type (Check all that apply)*

Conference/Symposium/Congress (International, National, Regional)

LMS

Presentation (Local)

Hands On

Webinar

Website

CD-ROM

Fellowship

other

Other

Are credit hours planned for this activity?*

Yes

If so, please provide the number of hours

Course Accreditation*

ACCME

ACPE

ANCC

Other

Identification of the CME provider (if applicable)

PREVIOUS TRIS PHARMA SUPPORT

To your knowledge, has the Requesting Organization received grant support in the last two calendar years?*

Yes

If yes, please describe the support type, name of program(s) and the approximate date(s) provided

How many attendees benefited from the previously supported program(s)?

What are the measurable outcomes from the previously supported program(s)?

MONETARY REQUEST DETAIL (IF APPLICABLE)

Please provide an itemized description of how grant monies will be used and the amount requested for each item:

Proposed Amount ($)

Description

An accounting detailing the expenditure of grant funds must be submitted to Tris Pharma within sixty (60) days of the end of the program/event, and any unused funds must be returned to Tris Pharma at that time.

By checking this box, I acknowledge the expenditure accounting and unused fund requirements.

DISCLOSURE OF FUNDING

State how Tris Pharma will be disclosed as a source of funding in any written or visual materials for the program*

DOCUMENTATION TO ACCOMPANY REQUEST FORM

Requesting Organization’s completed and signed W-9 (US) or W-8BEN-E (Canada)*

Max. file size: 32 MB.

Agenda and all hand-outs for the program/event*

Max. file size: 32 MB.

Implementation Plan*

Max. file size: 32 MB.

Needs Assessment or other documentation supporting program/event*

Max. file size: 32 MB.

Detailed program/event budget: a detailed budget is required for this request to be reviewed, including fair market value hourly rate and hours of work for any faculty honorarium*

Max. file size: 32 MB.

Signed letter of request on requesting organization’s letterhead*

Max. file size: 32 MB.

Accreditation documentation (if applicable)

Max. file size: 32 MB.

Details for Payment Details (mailed check)

Max. file size: 32 MB.

OPEN PAYMENTS DISCLOSURE

Section 6002 of the Affordable Care Act (also known as the Open Payments or Sunshine Law) requires Tris Pharma to report to the U.S. Centers for Medicare and Medicaid Services (“CMS”) all payments or transfers of value to physicians and/or teaching hospitals. If Tris Pharma determines that any grant funding or in-kind support is reportable to CMS, the grant recipient will be required to provide any and all information needed to facilitate proper reporting.

Your support for any educational endeavors to improve mental health outcomes

MEDICAL EDUCATION GRANTS

Grants- Medical Education

TRIS PHARMA MEDICAL EDUCATION GRANT REQUEST FORM

PERSON RESPONSIBLE FOR GRANT REQUEST

REQUESTING ORGANIZATION INFORMATION

APPROVED GRANT RECIPIENT

GRANT REQUEST DETAILS

NEEDS ASSESSMENT

PROGRAM/EVENT DETAILS

PREVIOUS TRIS PHARMA SUPPORT

MONETARY REQUEST DETAIL (IF APPLICABLE)

DISCLOSURE OF FUNDING

DOCUMENTATION TO ACCOMPANY REQUEST FORM

OPEN PAYMENTS DISCLOSURE

I am a United States Healthcare Professional

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Your support for any educational
endeavors to improve mental health outcomes