Merrimack Pharmaceuticals Medical Education Grant Request ... 2026

1. Click ‘Get Form’ to open the Merrimack Pharmaceuticals Medical Education Grant Request in the editor.
2. Begin by filling out the IME Provider/Partner Information section. Enter the provider name and address, and if applicable, include details about the accreditor or educational partner.
3. Indicate whether you have received previous grant support from Merrimack. If your previous program ended more than 90 days ago, ensure that you note if the reconciliation has been submitted.
4. In the Program Information section, attach any supporting documentation such as a needs assessment and line item budget. Fill in the date submitted, name of the program, and accrediting body.
5. Complete the Educational Objectives field and specify the media type (live, enduring, online, print). Indicate whether it is a single or multiple session program along with venue details.
6. Provide start and end dates for live programs and other programs. Specify your target audience and anticipated number of attendees.
7. Fill in Moore’s outcome levels to be reported and anticipated number of participants completing post-meeting outcomes. Lastly, complete the program budget and amount requested from Merrimack.
8. In the Requestor Attestation section, confirm that no Merrimack employee has influenced your proposal. Sign and date where indicated.

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