Charitable Contribution Application

Application Requirements

By submitting an application you are not guaranteed the approval of the funding request. Crinetics Pharmaceuticals follows a thorough review process and will approve or deny requests at its sole discretion.

In addition to a completed application, you will need to provide the following with your submission:

Letter of request, signed and dated on your organization’s letterhead, that includes the following:
- Program description that includes how you will use the contribution
W-9 form (US) or W-8 (non-US)
IRS tax determination letter (if applicable)
Before the approval of a charitable contribution, an agreement must be complete and fully executed

Charitable Contribution Application

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Crinetics Privacy Notice

With your consent, Crinetics will collect and use the information you submit here to indicate your interest in (i) supporting worthwhile causes through charitable contributions and/or (ii) supporting certain educational and professional activities by providing sponsorships to recognized institutions. Crinetics will collect, record, and use your information for the limited purpose of contacting you and determining your eligibility to participate in the above. Should you be eligible, Crinetics may use additional information you provide to assess your ability to contract with Crinetics. If you are selected, you will be contacted by Crinetics’s Corporate Affairs and Finance teams. Please make sure you review this Privacy Notice and consent statement before you submit your personal information. The use of your personal information for this limited purpose requires your explicit consent. If you consent to the use of your personal information as described below, please click the “YES” button on the bottom of this screen. You may revoke your consent at any time by contacting Crinetics using the information provided below.

Which information about you will be used?

Crinetics will record and use your personal information for the limited purposes described above. This information may include: Your identity (such as your name and email address), and other information you may choose to provide to us through our website, which may include sensitive information (e.g. financial information) under applicable privacy laws. In accordance with our privacy policy below, Crinetics does not sell personal information.

Who will have access to my information?

Only the Crinetics Corporate Affairs, Finance and Legal teams will have access to the personal information you provide. Your personal information will be protected and will not be shared with anyone outside the Crinetics Corporate Affairs, Finance and Legal teams.

For how long will my data be stored?

Information about you will only be kept as long as necessary to conduct the limited purposes described above. Unless Crinetics is required to retain your information for longer, for example, to meet a legal obligation, your personal information will be destroyed at the end of this period.

What are my rights?

As further detailed in our privacy policy, You have the right to ask what data we collect from you and why. You may request a copy of your personal information and, if technically feasible, ask for your information to be transferred to another person or group of your choice. You may verify the accuracy of your personal information, ask for it to be updated and/or corrected, and in certain circumstances, you may restrict further processing of and request deletion of your personal information. Finally, you have the right to exercise the above rights without being treated in a discriminatory way. However, please note that these rights are not absolute, and conditions may apply. Additionally, if you withdraw your consent, your information will no longer be collected and reviewed for the purposes stated above.

Whom can I ask questions about the protection of my data?

If you have any questions about your personal information or if you wish to exercise those rights afforded to you above, please visit crinetics.com/privacy-policy. Additionally, you may contact Crinetics’ Data Privacy team at [email protected].

Institution Name*

Date of application*

Contact Name*

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Description of intended use of contribution funds*

Requested amount (US$)*

Key Points for Consideration

If your request for support is approved, you will be required to enter into a written agreement with Crinetics. Please ensure that your institution is willing to abide by standard agreement terms before proceeding with submission of your application.

Supporting Documentation*

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