Medical Education Grant 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:
- Educational objectives
- Needs assessment
- Agenda
- Full program budget
- Program description that includes how you will use the grant
- Anticipated number of participants
- Name of accrediting body and provider, including type and amount of credits (must be accredited)
IRS tax determination letter (if applicable)
Before the start of a medical education grant, an agreement must be complete and fully executed.

Medical Education Grant Application

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Phone

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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 potential funding to conduct Investigator Initiated Studies (IIS), or other opportunities for Independent Medical Education (IME). Crinetics will use your information for the limited purpose of determining the eligibility of your application for funding, and should Crinetics provide funding, your ability to contract with Crinetics and receive payment. If you are selected, you will be contacted by Crinetics Medical Affairs or Finance team. Please make sure you review this IIS/IME Privacy Notice and consent statement before you submit your personal information. Crinetics will collect, record and use your personal information solely for the purpose of determining whether you qualify for funding. 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. Please make sure you review the privacy notice and consent statement presented to you below before you submit your personal information. Crinetics will collect, record and use your personal data solely for the purpose of determining whether you may qualify for a Medical Education Grant. The use of your personal data for this limited purpose requires your explicit consent. If you consent to the use of your personal data as described below, please click the “YES” button on the bottom of this screen. You may revoke the consent at any time by contacting Crinetics at 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, email address and phone number), and certain information which may be considered sensitive information under applicable privacy laws, including financial information used to fulfill the above mentioned purposes.

Who will have access to my data?

Only the Crinetics Medical 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 Medical 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 purpose described above. At the end of this period, your personal information may be destroyed or anonymized.

What are my rights?

You have the right to ask what data we collect from you and why. You may request a copy of your personal information and/or ask for your information to be transferred to another person or group of your choice. You may also correct or request deletion of your information, restrict further use, and revoke your consent to our processing 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, you may contact Crinetics’ Data Privacy team at dataprivacy@crinetics.com.

Institution Name*

Date of application*

Investigator (or Contact Name)*

Phone*

Email*

Address*

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

Purpose of grant*

Therapeutic Categories*

Acromegaly

NETs / Carcinoid Syndrome

Cushing's Syndrome

CAH

Other

Description of intended use of grant funds*

Requested amount (USD)*

Estimated total budget for the program, activity, event, etc.*

Estimated timeline for completion of activity*

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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