Welcome to the AstraZeneca MEGO on-line grant application. Please read all instructions carefully to ensure that your application packet is submitted appropriately.

We recommend that you click here to print a copy of these instructions prior to completing the on-line process. The following checklist provides a detailed summary of application requirements. As you can see, the application requirements include documents in addition to the grant application form. Where possible, we have provided electronic templates to facilitate easy on-line completion. Where original documentation is required, we have provided instructions for attaching files to your on-line application. However, in order to expedite your grant request, we encourage the use of the on-line process. For your convenience, you are now able to save a grant and complete it at another time.

If you do not have electronic versions of the required attachments, you may mail them to us under separate cover please include the MEGO Attachment Cover Letter with your mailed attachments to ensure that they can be linked to your electronic application form. Please be sure to include the Grant ID, generated at the end of the application process, in the cover letter and all of your documents.

For details on how to obtain telephone feedback on whether your proposed program is consistent with our areas of educational interest and available funding, please click on the General Information link and read about our RAPID Line.

Grant Application Checklist

Your completed grant application must include the following components in order to be considered for funding by the AstraZeneca Medical Education Grants Office.  If you are requesting funding for a Fellows Program, please scroll down to the Guidelines for Grant Requests for Fellowships and Healthcare Professionals-In-Training.

	A formal Letter of Request on the letterhead of the organization requesting the grant
	Completed Grant Application Form Click here for the on-line Application Form.
	Budget Schedule Click here for the on-line Budget Schedule. When completing the budget schedule, please provide a budget breakdown of only the costs that the requested AstraZeneca grant will support. If AstraZeneca is partially funding the program, please record the total program cost on the grant application. Please Note: There are three budget schedules on our Budget Schedule Template to select from: one for grant requests less than or equal to $50,000 (tab 1), one for grants over $50,000 (tab 2), and one for Fellows programs (tab 3). Please select the appropriate Budget Schedule Tab when submitting the grant application. Thank you! Please do not submit funding requests for the following: o  Travel, registration, parking or lodging expenses for non-faculty healthcare professionals to attend accredited or non-accredited continuing education programs o  Exhibit or display booths at conventions/conferences o  Research or health economics studies o  Charitable contributions o  General/miscellaneous education funds to support promotional education programs o  Social events o  Testimonial dinners o  Medical missions to foreign countries o  Medical school yearbook advertisements o  Medications o  Private schools/colleges/universities attended by physicians or their family members
	Proposal Click here for an on-line Proposal Template. If you prefer to use your own document, please be sure to include the following information: Program Title Full Program Description Program Date and Time if multiple dates and locations, please indicate all planned sessions Number of Faculty Needs Assessment or Equivalent Documentation A Needs Assessment is the centerpiece of the program planning process. It identifies gaps in knowledge for the targeted audience. AstraZeneca requires a needs assessment or equivalent documentation as to how your organization determined a need for the education and how the educational program will fulfill that need. Note that disease state prevalence is not considered substantial information. Learning Objectives Please describe what the participant should be able to do following program participation Description of how the program is intended to create changes in behavior that will lead to better patient care Description of how you will maintain full control of the content of the program, including speaker/moderator/audience selection, the budget, and the planning of the program Brief overview of the providers history (e.g., accreditation status, past program evaluations, description of your record of providing programs that meet standards for independence, balance, objectivity or scientific rigor, etc.) Description of how the audience will be recruited. If you plan to seek assistance from AstraZeneca in the distribution of invitations, please include a specific request in your Proposal, and refer to the AstraZeneca Independent Education Grants Office brochure here for information about how we can assist. Discussion of whether the proposed program will include an opportunity for commercial booths, and if so, where the booth will be located. Please note that if there is an opportunity for a booth, any associated costs must be included in the Proposal discussion. Also, please include contact information for the booth/display opportunity that can be shared with our Field Force. Description of the metrics that you will track for your planned program. Examples include: o  Number of invitees o  Number of attendees o  Number of attendees who received CE credit o  Program evaluation results o  Content-specific survey o  Speaker evaluation
	Program Agenda and/or List of Topics Draft copies are acceptable.
	Program Brochure Draft copies are acceptable.
	Letter authorizing the delivery of grant check to a third party, if applicable This letter must be on the accrediting providers letterhead.

Guidelines for Grant Requests for Fellowships and Healthcare Professionals-In-Training

The following process applies to grant requests involving fellowships or other educational programs for healthcare professionals-in-training. Examples include:

• Fellows or Professionals-in-Training educational programs
• Fellows or Young Investigator Awards
• Fellowships at Academic Institutions
• Scholarship programs operated independent of AstraZeneca
• Research internships for medical students and other trainees at academic institutions
• Support for junior faculty awards (similar to fellowships)

Required Documentation for Educational Programs

• Letter of request from Department Chair or Fellows Program Director on University letterhead or Associations / Specialty societies
• Stated purpose of the grant request and amount requested
• Organizations tax identification
• Overall educational objectives
• Description of eligibility requirements for fellow/post-graduate
• Needs assessment to encompass prior program feedback/evaluation where applicable Description of the selection process and criteria used in evaluating recipient
• Budget (see Fellows tab on Excel spreadsheet)

Please do not include CVs of fellows or any information regarding the content of the scientific information these fellows may be presenting.

Required Documentation for Fellowships

• Letter of request from Department Chair or Fellows Program Director on University Letterhead or Associations/Specialty Societies
• Stated purpose of the grant request and amount requested
• Organizations tax identification
• Overall educational objectives
• Description of eligibility requirements for fellow/post-graduate
• Description of the selection process used in evaluating candidates for fellowship
• Budget (see Fellows tab on Excel spreadsheet)