Grant Partnership Interest Form
_____________________________________________________________________________________________

AANP requests that any medical education companies interested in applying for a grant with AANP first complete the Grant Partnership Interest Form. This application allows AANP to quickly evaluate the overall scope of your organization's program and whether it matches AANP's funding priorities.  If approved, you will be encouraged to complete AANP's Grant Application.  Please note that the approval of the Grant Partnership Interest Form serves as a preliminary review of your program and not a full approval for a grant.  If you have any questions about this form, contact Chris Garza, AANP Grants Coordinator, at 512-442-4262 ext. 5220 or cgarza@aanp.org.


Medical Education Company Contact Information

Company Name
Name
Title
Street Address
 City
State
Zip
Phone
Fax
Email
Website
Is your organization:
     


Possible Supporters

Possible Supporter 1  
Possible Supporter 2  
Possible Supporter 3  
Possible Supporter 4  


Program Description

Topic/s  
Program Summary - In 100 words or less, describe your program and its main goals and objectives.
Type of Program (mark all that apply)


Is this program:






Collaborators

Will there be other collaborators?
     
If yes, what group/s?
Group 1  
Group 2  
Group 3