Requests For Support of a Charitable Contribution

• Request must be from a 501(c)3 organization (documentation required)
• Applications will only accepted during January, March, May, July, September, and November. Please click here for the 2010 application periods.

Application Requirements

1. Signed letter of request on organizational letterhead that includes the following information.
   • Description of request
   • Total dollar amount of funds being requested and how the funds will generally be used
   • Organization's mission statement*
   • Description of geographic area and population served*
   • Number of individuals served by organization each year (if applicable)*
   • Description of whether organization's activities are limited to patient/treatment education vs broader advocacy*
   • List of board of directors, trustees and key staff*
2. 501(c)3 determination letter from IRS
3. W-9 form
4. Annual operating budget
5. Verification document (available below)

*If your organization produces an annual report, it may be submitted to fulfill these information requirements.

Click here to download the verification form (required).

To Submit Your Request:

Tibotec Therapeutics only be accepts requests for fundraising support via an online submission system.

In order to submit a request, you will need to create an account with the Tax ID of your organization, email address, and password. You will be required to upload electronic versions of the documents listed above as part of your application.