Diabetes Care-Related Charitable Support Application

 

(xxx) xxx-xxxx
xx-xxxxxxx
One file only.
5 MB limit.
Allowed types: pdf.
Is your organization recognized by the IRS as a tax exempt, public charity under sections 501(c)3 and 501(c)6 of the Internal Revenue Code?
Is your organization a US governmental organization (e.g., public school, public college or university, public hospital or federally recognized Indian tribal government)?
Is your organization located in the United States?
Will the event/request take place in the United States?
Is the event related to the diabetes disease state?
Is your organization owned wholly or in part by a physician or a group or physicians, including group practices, privately owned physician offices, or charitable foundations of small group practices?
Is your organization a political or sectarian organization?
Will the funding be used for one of the following: Advertising, Alumni Drives, Capital Funding, Continuing Medical Education, Infrastructure, Memberships, Professional Sporting Events or Athletes, Religious Causes, Scholarships, or A Specific Individual?
Will Roche be the sole supporter of the event or program?

Request Address

You may request up to five product types.

One file only.
5 MB limit.
Allowed types: pdf.