Medical Education Grant Requests

Before consideration, a grant application must contain all of the following documents:

  • Letter of Request - including a robust needs assessment that demonstrates an educational need for the program and a brief description of who is requesting the grant, what is being requested, the date, and the location of the activity
  • Agenda or brochure - including a detailed description of the event or a synopsis of materials to be created
  • Budget - a detailed budget for the total event/project, including: (a) the total amount of funds requested from Ipsen Biopharmaceuticals, Inc.; (b) a breakdown of expenses and projected number of attendees; (c) the percentage of funding requested from Ipsen Biopharmaceuticals, Inc., to the total funding for the activity; and (d) the number of sponsors that are being approached to support the event. Preference will be given to those events funded by more than one sponsor
  • W9 - tax form with tax ID number for the entity receiving the check. If an entity is tax exempt, you may submit a Letter of Exemption instead. Click here to download a W9 form
  • Letter of Agreement (LOA) - the Ipsen Biopharmaceuticals, Inc., US Letter of Agreement is required for funding all grant requests. Please click here for the LOA Template. Please complete the form, sign, scan, and upload
  • CE Certificate - CE certificate for the provider. This requirement is waived for non-CE educational activities


A detailed report on the final number of attendees, an evaluation of the program, final budget reconciliation and a refund of any unused portion of the Ipsen Biopharmaceuticals, Inc. grant funds must be sent to the Grants Administrator within 90 days following completion of the program. Subsequent grant requests will not be considered until the evaluation and reconciliation are received.

To request a grant, please fill out the following form.

    (check all that apply):
  • Accepted file types: pdf, doc, docx.
  • Accepted file types: pdf.
  • Accepted file types: pdf, doc, docx, xls, xlsx.
  • Accepted file types: pdf, doc, docx.
  • Accepted file types: pdf.
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