ORTHO MCNEIL PHARMACEUTICAL : Forms

Eligibility
Therapeutic Areas of Interest
Exclusions
International Support
General Guidelines
     i.   Requirements for Educational Grant Requests ≤ $10,000
     ii.  Requirements for Educational Grant Requests > $10,000
     iii. Requirements for Educational Grant Requests ≥ $50,000

ELIGIBILITY

Educational Grant requests can be in the form of:

CE Grants
- Independent medical educational programs/activities with accredited providers (e.g., CME, AAFP, ANCC, ACPE)
Non-CE Grants
- Independent educational programs/activities in affiliation with educational providers, which may include academic centers, hospitals, medical societies, patient advocacy groups, etc.
- Development of patient and/or healthcare professional educational materials
- Resident/Fellowship support
Each educational grant request must contain ALL required completed forms and must be submitted at least 10 weeks prior to the date of the event to ensure sufficient time for review.
- OMJSA reserves the right to deny requests not submitted in this timeframe.
- Faxed and mailed grant submissions are no longer accepted
- Only file types such as .doc, .xls, .pdf may be attached with grant submissions. We do not accept zipped files (.zip).
- Grant is subject to rejection, if information is incomplete or missing.
- Receipt of a grant request by OMJSA does not guarantee approval of your grant request nor financial support in the entire amount being requested.

If the activity will be certified for continuing education credits, the grant request must be submitted by the organization providing credits/units on official letterhead with signature.
- CE Provider Questionnaire must be filled out, signed and included in the submission
If additional information is requested, please include the requester’s Grant ID number and program description that was provided with the original submission in any correspondence for identification purposes.

Each educational grant request must contain a statement of how disclosure of financial support will be made to program participants for the educational activity. OMJSA’s recommended statement is: “Supported by an educational grant from (insert operating company name) administered by Ortho-McNeil Janssen Scientific Affairs, LLC”. Company logos will be provided upon request.
If a Medical Education Company’s services will be utilized for the educational activity, the Certification of Separation form must be filled out, signed and included with the submission.

Upon successful submission of a educational grant request, OMJSA will:

Provide a Grant ID number immediately upon receipt of a grant application. If you do not receive a confirmation receipt with the grant ID number, please contact the Help Desk at Totalitysitemgr@omjus.jnj.com
Notify the contact person from the requesting organization regarding the status of the request (e.g., approved, denied, additional information required ) within 8 weeks of receipt.
E-mail a .pdf version of the Educational Grant Agreement (for approved grant requests) to the requesting organization for signature.

THERAPEUTIC AREAS OF INTEREST

ORTHO WOMEN'S HEALTH & UROLOGY^TM, a Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc,

Women's Health - Hormonal Contraception
Interstitial Cystitis

EXCLUSIONS

Educational Grants Cannot Be Used To Support:
Requests outside our therapeutic areas of interest	Promotional activities related to products of Operating Companies supported by OMJSA
Development of treatment guidelines	Used to pay travel, lodging, conference expenses or honorarium for an applicant presenting a poster or paper
Normal organizational overhead, e.g., purchase of computer equipment, staff training	Charitable fundraising events and charitable contributions. If you are a 501(c)3 organization seeking support, forward an e-mail message to contributions@janus.jnj.com
Reimbursement for physicians or other attendees for the cost of obtaining CME credits	Programs that have already occurred
Food and beverage expenses at non-accredited programs

INTERNATIONAL SUPPORT
OMJSA does not generally support international programs. However, if the attendees are predominantly US-based, we may consider an application on an exception basis.

REQUIREMENTS FOR EDUCATIONAL GRANT REQUESTS <=$10,000

Signed LOR on organizational letterhead which includes:
- Statement of educational need for the proposed activity
- Program overview, date and location
- Accreditation information (if applicable)
- Program agenda and/or topics and faculty (confirmed or proposed, if applicable)
- Funding amount and utilization of requested funds
- Each educational grant request must contain a statement of how disclosure of financial support will be made to program participants for the educational activity. OMJSA's recommended statement is: “Supported by an educational grant from (insert operating company name) administered by Ortho-McNeil Janssen Scientific Affairs, LLC”. Company logos will be provided upon request.
Other Required Forms – please ensure that each grant submission includes templates from the Web site as revisions may be made at any time.
- Budget Template Form - provided in the Forms section on the company Web site.
- Signed Continuing Education Provider Questionnaire (if applicable, to be completed by the accreditor)
- Signed Certification of Separation Form (if applicable)

REQUIREMENTS FOR EDUCATIONAL GRANT REQUESTS >$10,000

Signed LOR on organizational letterhead which includes the following:
- Statement of educational need for the proposed activity
- Program overview, date and location
- Accreditation information (if applicable)
- Program agenda and/or topics and faculty (confirmed or proposed, if applicable)
- Funding amount and utilization of requested funds
- Each educational grant request must contain a statement of how disclosure of financial support will be made to program participants for the educational activity. OMJSA's recommended statement is: “Supported by an educational grant from (insert operating company name) administered by Ortho-McNeil Janssen Scientific Affairs, LLC”. Company logos will be provided upon request.
Educational Grant Proposal that includes a detailed explanation of all of the following:
- Needs assessment, which may include literature search, surveys, KOL interviews, etc.
- Learning objectives
- Education format
- Description of enduring materials (if applicable)
- Target audience and anticipated number of participants
- Outcomes and/or evaluations from past programs
- Any proposed educational outcomes measurements of current activity
Other Required Forms – please ensure that each grant submission includes templates from the Web site as revisions may be made at any time.
- Budget Template Form - provided in the Forms section on the company Web site.
- Signed Continuing Education Provider Questionnaire (if applicable, to be completed by the accreditor)
- Signed Certification of Separation Form (if applicable)

REQUIREMENTS FOR EDUCATIONAL GRANT REQUESTS ≥$50,000

Signed LOR on organizational letterhead with a general overview of the proposed educational activity and logistics.
Educational Grant Proposal that includes a detailed explanation of all of the following:
- Detailed needs assessment and learning objectives for the proposed educational activity or platform, which should include information about the source(s) and methodology used to identify the medical educational need(s). It is strongly recommended that at least 3 separate sources are utilized to support the identified educational need.

Examples of sources used to perform a needs assessment may include:

Interviews
Questionnaires/surveys
Practice pattern analysis
Focus groups
Literature review
Previous CE activity evaluations or educational outcomes
Quality Insurance/Quality Assurance (QI/QA) data analysis

Program agenda and/or topics and faculty (confirmed or proposed, if applicable
Criteria for selecting faculty
Description of all components that are part of the educational activity
- For educational programs with multiple components or materials a diagram or schematic is strongly recommended
Plan for recruiting and generating program awareness
- Anticipated number of participants, including recruitment efforts
Proposed timelines for major components and major milestones
Funding amount and utilization of requested funds
Any proposed educational outcomes measurements of current activity
Each educational grant request must contain a statement of how disclosure of financial support will be made to program participants for the educational activity. OMJSA's recommended statement is: “Supported by an educational grant from (insert operating company name) administered by Ortho-McNeil Janssen Scientific Affairs, LLC”. Company logos will be provided upon request.
Roles and responsibilities of CE Provider and Medical Education Vendor (if applicable)

Other Required Forms – please ensure that each grant submission includes templates from the Web site as revisions may be made at any time.
- Budget Template Form - provided in the Forms section on the company Web site.
- Signed Continuing Education Provider Questionnaire (if applicable, to be completed by the accreditor)
- Signed Certification of Separation Form (if applicable)

All required forms and therapeutic areas we support are found on our company Web sites under Medical Education.

www.janssen.com
www.mcneilpediatrics.net
www.ortho-mcneil.com
www.ortho-mcneilneurologics.com
www.ortho-mcneilpharmaceutical.com
www.pricara.com
www.sciosinc.com

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