Teleflex Medical Education Grant Request Form

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

  • Teleflex provides cash or in-kind support for accredited medical educational programs or events which promote genuine scientific or educational discourse.

  • Teleflex 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.

  • Teleflex 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 Teleflex 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
Requesting Organization Information
Approved Grant Recipient

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

Grant Request Details
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
  • Market Research on Professional Needs
  • Observed Data
Program/Event Details
Previous Teleflex Support
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
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Disclosure of Funding
Product/in-kind Support Request Detail (if applicable)
Product Name/Code Product Size/Dimensions Requested Quantity of Product (e.g. 3 each, 2 kits)
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Technician Support Request Detail (if applicable)
Documentation To Accompany Request Form
Open Payments Disclosure

Section 6002 of the Affordable Care Act (also known as the Open Payments or Sunshine Law) requires Teleflex 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 Teleflex 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.