Grants and Donations Form

The personal information about you that AbbVie Corporation ("AbbVie") collects as part of your grant or donation request is subject to our Privacy Policy, which outlines how we use and what rights you have regarding your data.

Name of the requesting entity * Enter valid entity name

Name of requesting individual * Enter valid individual name

E-mail of the requesting individual * You've entered an invalid e-mail address

Street * Please enter street name

City, Province * Please enter city, province

Postal code * Please enter a valid postal code

Telephone * Please enter a valid telephone number

Legal authorized representative to sign contract

Legal authorized representative name * Please enter a valid name

Legal authorized representative title * Please enter a valid title

Legal authorized representative e-mail * Please enter a valid e-mail

Registered Charity
Non-Profit Organization
Public / Government owned Healthcare Institution
Private Clinic or for profit organization

Entity type *

This is a required field and cannot be blank

Registration Number * Please enter your registration number

Briefly outline your funding request (75 to 200 characters)

of 200 characters available This field is required with minimum 75 characters

Is it a donation? *

YES NO

Please choose the category that best fits your request out of the three below:

Improve delivery of care for patients Advance patient health equity Improve patient outcomes and access to care

Briefly describe how the initiative will directly affect patients? (200 characters maximum)

of 200 characters available This field is required with minimum 75 characters

Briefly describe how the initiative will directly affect patients? (200 characters maximum)

of 200 characters available This field is required with minimum 75 characters

Briefly describe how the initiative will directly affect patients? (200 characters maximum)

of 200 characters available This field is required with minimum 75 characters

A tangible benefit is a direct benefit (i.e., legitimate, quantifiable, appropriate, and business-oriented benefit) received by AbbVie.

Tangible benefits can include:

Booth/exhibit/display;
Corporate visibility (beyond simple recognition of AbbVie, i.e. logo on website, event materials and/or programs, etc.)

Will AbbVie receive a tangible benefit? *

YES NO

$ Amount requested (CAD) * Please enter valid amount

As approval and contract execution are required prior to the start date of your project, we ask that you provide us with a 60-day minimum lead time to allow for processing.

If your request is less than 60 days away, please e-mail [email protected] to obtain a PDF version of this application form, as you will not be able to submit your application through the Web site.

Project start date * Start date is required

Project end date * End date is required

Migraine
Psychiatry
Spasticity
Movement Disorder

Neuroscience Sub Item *

This is a required field and cannot be blank

Other therapeutic area * This is a required field and cannot be blank

The required documents to be attached are as follows:

Signed and dated letter of request on your organization’s letterhead;
Detailed budget breakdown;
Article of Incorporation (or any legal document attesting of your entity’s legal status).

Failure to attach requirement documents may result in the rejection of your request.

Have funds been solicited from other sources? *

YES NO

ATTACHMENTS *

Please upload a valid attachment type with maximum size of 25MB. If you continue having issues, please e-mail your letter of request directly to [email protected].

Allowed File Types : PDF, Word, PowerPoint, Excel

By checking this box, the applicant confirms that none of its executive members have an actual or potential conflict of interest with AbbVie or Allergan. *

I have attached all of the required documents (signed and dated letter of request on the organization’s letterhead, detailed budget breakdown, and an article of incorporation or any legal document attesting to the entity’s legal status). *

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*As part of our ongoing commitment to maintain a high level of integrity of our grants and donations program, we review our selection criteria on an ongoing basis.

At AbbVie in Canada, we acknowledge that we live and work on the traditional territories of many First Nations, Inuit and Métis Peoples. We would like to show respect to those Peoples who are the original and ongoing stewards of this land we call our home. We are grateful to collaborate on these traditional lands and humbled by the work that we do to enhance people’s lives in our communities.

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Grants and Donations Form

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