Educational Program Grant Application - Northern New England Clinical Oncology Society – Northern New England Clinical Oncology Society

Educational Program Grant Application

NNECOS will award a limited number of educational grants (typically ranging between $500 and $4,000) in sponsorship of local educational activities. NNECOS will accept requests for applications (RFAs) from NNECOS members to support an educational endeavor (clinician-focused or patient‐focused) at their practice or institution. These meetings will not be CME‐sponsored. NNECOS will review applications on a rolling basis until available funding has been awarded.

Guidelines

Applicant Responsibilities:

Submit plans for meeting and budget via online application process
Be a current NNECOS member
Assume all responsibility for adhering to his/her practice or institution guidelines
Provide appropriate recognition/acknowledgment of NNECOS as program sponsor
Provide post-event report/documentation, within 7 days of the event, including a summary of the meeting attendance, budgetary issues, etc.

Recommendations

NNECOS encourages the use of local expertise within the NNECOS and tri-state area for faculty

NNECOS Responsibilities:

Review proposals and provide feedback
Provide guidance as requested
Provide funding in a timely manner

Fields marked with an * are required.

Employed by Industry *

Are you employed by a company not directly involved in patient care (i.e., pharmaceutical, medical device, or diagnostic/testing company, etc)?

Applicant Information
Please complete the following information.

First Name *

Last Name *

Organization *

Email *

Credentials *

Include professional credentials, certifications, or other identifiers you'd like associated with your name.

Professional Background

Qualifications/Identification *

In 2-3 sentences, please state your qualifications and/or background as an introduction to who is applying for the grant.

Proposed Activity

Topic for Proposal *

Tentative date of program *

Short description of project: *

Tentative Speaker(s) *

Please describe your intended presenter(s) for this program.

Budget

Detailed budget *

Please provided a detailed description of your budget (speaker honorarium, food/beverage support, facility support, etc), including the total amount of request.

Target Audience

Anticipated Audience *

Expected Attendance *

NNECOS Recognition

How will you promote NNECOS as the sponsor of this activity? *

Include specific recognition/promotion plans such as verbal acknowledgement during the session, logo/recognition in marketing materials, etc.

Additional Documentation/Uploads

Attachments

If applicable, please attach any additional documentation, such as presenter, CV, etc.

20MB max

How did you hear about this opportunity? *

Certification

By submitting this application, I certify that *

I am a current NNECOS member in good standing

I assume all responsibility for adhering to my practice or institution guidelines

I will provide appropriate recognition / acknowledgment of NNECOS as program sponsor

I will provide post-event report/documentation, within 7 days of the event

I will maintain active NNECOS membership throughout the funding and service period

Signature *

Type your full name below to serve as your electronic signature and certify the statements above.

Please verify that you have checked the “I'm not a robot” checkbox.