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Online Request Form for Healthcare Educational Grants

grantsform header image

Online Request Form for Healthcare Educational Grants

Form Instructions

This is an application form to request support for educational grants. GE HealthCare's receipt of this form does not imply a commitment to approve the application or provide any requested support.

 

For GE HealthCare Pharmaceutical Diagnostics (PDx) Requests ONLY: If seeking to apply for an unrestricted medical education grant, GE HealthCare Pharmaceutical Diagnostics collaborates with the global healthcare community to address knowledge gaps and improve patient outcomes. Independent educational grants from GE HealthCare are available to support programs which are aligned with our medical and/or scientific strategies. Please use the alternative link below to apply:

https://www.cybergrants.com/pls/cybergrants/ao_survey.form?x_gm_id=2527&x_section_id=1494256&x_quiz_survey_id=53798

 

In order to be eligible for review, your request must be submitted 90 days in advance of your event to allow sufficient time for review and response to your request. You will receive confirmation or declination of your request within 45 days of your event

 

We are in the process of migrating our organization to our new @gehealthcare.com domain. Please whitelist @gehealthcare.com as appropriate to ensure our emails continue to reach your inbox as intended.

 

Please submit one application per event.

Please gather all the documentation prior to submitting your request.

 

Those documents may include, but are not limited to:

  • Agenda (Mandatory)
  • Budget (for cash grant requests)
  • Requesting Organization Tax Document (example – W9 for USA or VAT Number or Article of incorporation)

IMPORTANT: If support is approved, GE HealthCare Support Agreement will be utilized

 

Note: Please use the latest version of your browser for this form to render in it's full capacity.

Grant Requesting/Beneficiary Organization

* indicates a required field
Organization Name
Please enter Full Name of the Organization
Home Country of the Organization
  • Select Home country of the Organization
  • Canada
  • United States
Select Home country of the Organization
Product/Care area
  • Select Product/Care area
  • Imaging: Computed Tomography (CT)
  • Imaging: Interventional Guided Systems (IGS)
  • Imaging: Magnetic Resonance Imagining (MRI)
  • Imaging: Women’s Health (X-Ray)
  • Imaging: Molecular Imaging (MI)
  • Imaging: X-Ray
  • Ultrasound (AVS): Women’s Health (Ultrasound)
  • Ultrasound (AVS): Cardiovascular
  • Ultrasound (AVS): General Imaging
  • Ultrasound (AVS): Handheld
  • Ultrasound (AVS): Point of Care
  • Ultrasound (AVS): Primary Care
  • Ultrasound (AVS): Surgical Visualization and Guidance
  • Ultrasound (AVS): Urology
  • Patient Care Solutions: Anesthesia Delivery
  • Patient Care Solutions: Maternal & Infant Care
  • Patient Care Solutions: Patient Monitoring
  • Digital Solutions
Select Product/Care area
Name of the hospital/teaching institute
Please enter hospital/teaching institute name
Tax id Number
Please enter tax id number
Street address of the organization
Please enter Street address of the organization
Apt/Suite/Office
Please enter Apt/Suite/Office
City
Please enter City
State
Please enter State
Zip
Please enter Zip Code
Which department of the Organization is the request coming from?
Please enter Which department of the Organization request is coming from
Has the recipient received any grant from GE HealthCare in the past year? If so pls provide some details
Please enter details

Contact/Requester Details

* indicates a required field
Full Name
Please enter Full name
Organization you're working for
Please enter Organization
Phone Number
Please enter Phone Number Please enter a valid phone number, Only numbers allowed
Requestor title
Please enter Title

Support Type

* indicates a required field

It is mandatory to choose the type of support you are seeking for your event. You can select more than one option. If you don't make a selection, the review of your application will be delayed. All requests for charitable donations must be submitted directly by the non-profit organization via our on-line application at: https://www.gehealthcare.com/initiatives/community-engagement

Event Details

* indicates a required field
Event title
Please Enter Event Title
Venue Name
Please Enter Venue Name
Street Address
Please Enter Street Address
City
Please Enter City
State
Please Enter State
Zip code
Please Enter Zip Code
Country
  • Select country
  • Canada
  • China
  • France
  • Germany
  • India
  • Japan
  • Korea
  • United Kingdom
  • United States
  • US Military
  • US Virgin Island
Select country

*

Please Enter start date and end date
Program website
Please Enter Program Website
Purpose/Objective of Event
Please Enter Purpose or Objective of the Event
Who is the target audience?
Please Enter Target Audience
How many attendees are you expecting?
Please Enter expected attendees

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DISCLOSURE

* indicates a required field

The decision by GE HealthCare to provide support shall not be based on the volume or value or business generated or expected to be generated by the requesting organization. Requests for support will not be reviewed if submitted or influenced by sales personnel. You acknowledge that this request is consistent with your organization's guidelines and is not related to any commercial relationship, interest or transaction. 

 

Additionally, by signing, you acknowledge that your organization will be using only the GE HealthCare Support Agreement and will not accept any alternative agreements. Please sign and confirm that you are not attempting to use this request as part of a commercial negotiation or transaction.

*

Please Select date
Clear

Sign name using mouse or touch pad

Please Sign name using mouse or touch pad
Signature of
Please Enter your Name

Thank you for your submission!

Thank you for your request for support. GE HealthCare's receipt of this completed form does not imply a commitment to approve the application or provide any requested funding and/or equipment. Your request may take a minimum of 90 days to be reviewed. You will receive an email notification of our decision. We appreciate your patience during this process.