Program Organizer / Grant Requestor
Please do not use the form below to report an adverse drug event (ADE). You are encouraged to report Adverse Drug Events (ADEs) to FDA by visiting www.fda.gov/medwatch or calling 1-800-FDA-1088. Please enter the contact information for the program organizer.
For grants covering multiple meeting dates, please enter the first date and attach a course brochure or document containing all the meeting dates.
CE Provider / Course Sponsor (if applicable)
Please enter the contact information for the accredited CE provider for the course.
75% Specialists / 25% General Practitioners
50% Specialists / 50% General Practitioners
25% Specialists / 75% General Practitioners
100% General Practitioners
Describe the intended use of the funds:
Lecture Topics and Course Description of Content:
How will American Regent be recognized for support:
Describe how this program fits within American Regent Guidelines on CE sponsorship:
Payee Name / Teaching Hospital
Please enter the Payee Name and/or Teaching Hospital.
Please enter the Enduring Material information.
Your request for a CE sponsorship funding or grant will be reviewed and considered by American Regent’s Grant Committee. Review times may vary; however, typical review and response time will be 4 weeks. You may check on the status of your request by emailing us at