See Grant Guidelines for details on completing this form. Fields marked with * are required.

To avoid loss of submitted information:

Requesting Institution*
Medical Education Provider, if different from requesting institution:
Institution Contact*
Contact's Email*
Institution Address*

Attn:
If different from Institution Contact
Institution Country*
Institution City*
State/Province:* US/Canada only
Institution Postal Code*
Institution Phone* Ext:
Fax
Check box if remit to address is same as Institution address
Remit To*
Remit To Address*

Attn:
Remit To Country*
Remit To City*
State/Province:* US/Canada only
Remit To Postal Code*
Amount requested* $ (whole numbers only)
Total Program Budget* $ (whole numbers only)
Type of Request*
Number of anticipated attendees:*
Live: and/or Enduring:
Primary Target Audience:*
Second Target Audience(s):
Select all that apply.
Hold down the Ctrl or
Command key to select
multiple items or to deselect items.
Tumor Type(s):*
Select all that apply.
Hold down the Ctrl or
Command key to select
multiple items or to deselect items.
Provider Type:*
Select all that apply.
Hold down the Ctrl or
Command key to select
multiple items or to deselect items.
Multi-sponsored Event*
Exhibit Opportunity* This is for informational purposes only. All exhibit/display fees should be forwarded to your local Onyx Sales Representative and should not be included in this grant request.
CME-Accredited Activity*
If CME accredited, number of CME credits offered:
Program Title*
Brief Program Description *
(Maximum characters: 500)
Program Development Start Date *
(date work on the program is scheduled to begin, i.e., date that content development is initiated)
Congress/Conference Association
Geographic Region *
Venue Name #1* (click + for additional  
venues/dates)
Venue Address (insert web address, if applicable, for enduring events)*
Venue Type*
Select all that apply.
Hold down the Ctrl or
Command key to select
multiple items or to deselect items.

If "Other", describe:
Program Format*
Select all that apply.
Hold down the Ctrl or
Command key to select
multiple items or to deselect items.

If Live, is the event open to Industry Attendance?
Event Start Date (mm/dd/yyyy)*
Event End Date (if applicable)
Time of event
Proposed Faculty
(Maximum characters: 500)

*Proposed faculty and/or confirmed faculty must be filled in.
Confirmed Faculty
(Maximum characters: 500)

*Proposed faculty and/or confirmed faculty must be filled in.
Comments
(Maximum characters: 500)
Grant request letter on official institution letterhead (PDF format only)*: (PDF Help)
Program agenda/Program outline (PDF format only)*:
Program budget (PDF format only)*:
(click + for additional  
documentation)
Additional documentation (PDF format only):
Completed W-9 or W-8 (PDF format only)*: (Form Help)

By clicking the "I Accept" button below, you acknowledge and agree to the following:

  1. If the grant request is approved, acceptance of funding in no way obligates the recipient to purchase, prescribe, recommend, or otherwise influence the sale of Onyx products.
  2. For approved program funding, the recipient must retain full control over program content and/or materials at all times. Onyx may not be involved in the selection of program topics, speakers, attendees, or otherwise influence program content. Only upon written request from the recipient may Onyx provide limited technical or logistical assistance.
  3. Program materials should include disclosure of grant funding (e.g., "This program is made possible through an educational grant from Onyx Pharmaceuticals, Inc."). When applicable, any significant relationship between a speaker and Onyx must be disclosed during the program as well as any discussions relating to a use that has not been approved by the US Food and Drug Administration.
  4. Approved funds must be used toward the above-referenced event.
  5. Grants will only be awarded prospectively, with sufficient lead time for review and processing. "Supplemental" grant requests to cover program overages will not be approved.
  6. Grants are only awarded to legitimate institutions and medical organizations, not individual parties.
  7. Review of requests may take up to 30 days (45 days for large/complex grants). Review decisions will be communicated via e-mail to the address entered above.
  8. Grant requests are reviewed on a periodic basis by a multi-disciplinary Grant Review Committee which takes into account several factors including the educational value of the program to the patient and/or medical community, independence and quality of the program sponsors, and alignment with Onyx's therapeutic areas of interest.
  9. Incomplete requests, including those necessitating clarification following submission, will not be processed.
  10. Onyx is required to maintain a copy of all approved requests for accounting and compliance reporting purposes.

If you do not accept these terms, click "I Decline" to cancel this request.