Tech Grant Program

To apply for the Acclinet Corp. Technology Grant, fill out the form below. You should receive an e-mail confirmation shortly after submission. If you do not receive a confirmation, please contact us to make sure we received your application.

If the Acclinet Corp. Technology Grant committee determines you are a worthy candidate, we will contact you seeking further information. For students, a short recommendation from a professor, department head or other school administrator will be required.

Company Name:

First Name:

Last Name:

Address:

Phone:

Email:

Describe the type of equipment you're seeking in 200 words or less:

Describe why you need the equipment in no more than 600 words:

How did you find out about the Acclinet Technology Grant Program?

Do you certify that all the above information is true to the best of your knowledge? (Yes/No)

Verify: