1. Needs Assessment: A needs assessment is a short statement describing the unmet educational need that will be satisfied by this program and explaining how this need was determined (e.g., evaluations, literature, etc.).  This document must include a list of references for any evaluations, literature, or any other bodies of work that are referenced within the needs assessment.

2. Learning Objectives: Learning objectives describe the goals of the program or the key learnings that attendees are expected to take away after participating in the program.

3. Request Letter on Legal Letterhead: The letter of request should 1) be presented on the organization’s legal letterhead, 2) specify that the request is for support of an educational grant, 3) specify the total amount of funding being sought from Teva, 4) contain a summary description of the program, the date and venue of the program; and 5) contain a legal signature. Note: it may be necessary for the organization to scan and upload the request letter for it to contain the legal signature.

4. Sample Invitation/Flyer: A draft invitation/flyer with the actual program information should be uploaded or one from a previous program may be submitted.   This is a required field, so if no invitation/flyer, please upload a document stating this.

5. Agenda and/or Topics: The agenda/topics list should contain the list of potential topics or potential agenda that are being proposed for the educational program.

6. Budget: The budget document should be a detailed, itemized list of how the funds will be utilized for the program, if funding is granted. This should include all funds as well as Teva funds.  The supporting budget document should align with the budget entered in the online application.

7. 501c3 (if applicable): If you indicated that your organization is a 501c3 (non-profit), please upload your 501c3/IRS letter of determination. The letter is granted by the Internal Revenue Service and indicates which section of the Internal Revenue Code your organization is qualified. The determination letter is the only official document that provides proof that your organization is recognized as a tax-exempt organization.

8.  Board of Directors Document: Most organizations should have a board of directors document, which clearly lists the organization’s board of directors. Please provide titles and credentials of each board member.

9. Roles & Responsibilities Document for Honoraria: This document should contain a full bullet pointed list of faculty roles and responsibilities for each honoraria line item listed in the online budget application. Next to each bullet point, please list the estimated number of hours associated with each role and responsibility entered.  Please provide the credentials for the faculty members receiving honoraria. Please note: the estimated listed number of hours should total the number of hours allocated in the RMS Portal honoraria section-number of hours column.  For example, if 5 hours is listed, the total number of hours next to each role/task should total 5 hours.

 

Please see the following recommended format, provided for your guidance only, to assist you in providing the roles and responsibilities document.

Required Documentation

Exhibit Opportunities With a Live Patient Education Program

If your request notes an exhibit opportunity as part of a patient program, please be aware that if this request is approved, the grant cannot be put toward the exhibit booth.  Please include a document noting the location of the exhibit area in relation to the educational venue.

Teva is committed to conducting business in compliance with all applicable federal and state statutes and regulations.

For any inquiries email: tevarequestmanagement@tevapharm.com or call: 800-961-3604.

Please include the grant number if applicable.

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