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Grants & Charitable Donation Request

Novocure is dedicated to supporting independent organizations with shared goals for advancing medical care and improving patient outcomes.

This form allows you to submit a proposal seeking Independent Medical Educational Grants and Charitable Contributions.

I agree with novocure's special security policy

What is the legal name of your organization? *^*

In which country is the organization located? *^*

United States of AmericaFranceGermanyUnited KingdomSpainItalyJapanIsraelOther…

Enter other…^*

What is the complete address of the organization (country, state, city, street & number)? *^*

What is the website of your organization? *^*

What are the organization's areas of focus? *^*

What is the organization’s annual operating budget? *^*

What is the name of the authorized signer for a potential Grant or Donation from Novocure? *^*

What is the email of the authorized signer for a potential Grant or Donation from Novocure? *^*

Has the organization previously received funding from Novocure in the last 5 years? *^*

YesNo

Is the project an educational activity for health care professionals? *^*

YesNo

Is your organization a non-profit? *^*

YesNo

What is the title of the project which you seek funding for? *^*

Project start date*^*

Project end date *^*

What is the total budget of the project? *^*

What amount are you seeking funding at Novocure for? *^*

What's the purpose & expected outcomes of your project (for events please add the agenda)? *^*

What type of individuals are expected to benefit from the funds provided by Novocure? *^*

Is the project taking place online or on site? *^*

OnlineOn SiteOnline & On Site

In which country(ies) is the project or program taking place? *^*

United States of AmericaFranceGermanyUnited KingdomSpainItalyJapanIsraelOther…

Enter other…^*

If the project is either onsite or both online and on site, then please provide the name and address of the venue: *^*

Is other financial support being sought for the project or program? *

YesNo

What is the title of the project which you seek funding for? *

Project start date*^*

Project end date *^*

What is the total budget of the project? *^*

What amount are you seeking funding at Novocure for? *^*

What's the purpose & expected outcomes of your project (for events please add the agenda)? *^*

Is the project taking place online or on site? *^*

OnlineOn SiteOnline & On Site

In which country(ies) is the project or program taking place? *^*

United States of AmericaFranceGermanyUnited KingdomSpainItalyJapanIsraelOther…

Enter other…^*

If the project is either onsite or both online and on site, then please provide the name and address of the venue: *^*

What's the target audience? *^*

Local

National

International

How many HCPs are expected to benefits from the funds provided by Novocure? *^*

Is the expected audience from a single institution? *^*

YesNoMaybe

Is other financial support being sought for the project or program? *^*

YesNo

What is the anticipated revenue from registrations (if applicable)? *^*

What are the learning objectives of the project? *^*

How will you measure the learning outcomes of the project? *^*

Is the program accredited? *^*

YesNo

Is your organization the accreditor of this project? *

YesNo

This form was completed on behalf of the requesting organisation; The information provided in this form and supporting documents is true and accurate; The grant request is not implicitly or explicitly linked in any way to past, present or potential future purchase, lease, recommendation, prescription, use, supply or procurement of the Company’s products or services? *^*

YesNo

I confirm the funds provided by Novocure will not go towards speaker fees, meals, medical equipment or individual operating cost *^*

YesNo

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