Globus Cares Application

surgeon with device
  • The following application is intended for requests to support Surgical Mission Trips. Please be sure you understand each of the following guidelines before submitting your request.

    • Globus is unable to provide a donation if the trip is not supported by a 501(c)(3) organization. Approved funding cannot be issued to an individual.
    • The focus of the trip must be on the treatment of patients, free-of-charge, with spinal pathologies, that otherwise would not receive care, and where appropriate may include the educating of spine surgeons servicing the region.
    • Through the Globus Cares Program, we aim to support missions to as many different locations as possible in a calendar year. As such, support to the same locations may be limited. Please reach out to grants@globusmedical.com prior to the completing an application to determine if a particular location is still open for applications in the given year.
    • Requests must be submitted AT LEAST 3 months (12 weeks) prior to the intended dates for the trip.

    If you are unsure if you are completing the correct application or if you are eligible for the Globus Cares Program, please reach out to grants@globusmedical.com for assistance.

  • Contact Information

  • Requestor Information
  • Primary Contact Name (if different from requestor)
  • Globus Medical Rep (if known)
  • Request Information

  • Organization Information

  • If no, please provide the payable information below:
  • Specific Mission Trip Information

  • Attachments

  • Accepted file types: jpg, pdf, doc, docx, csv, xls, xlsx.
    Allowed file types: jpg, pdf, doc, docx, csv, xls, xlsx
  • Accepted file types: jpg, pdf, doc, docx, csv, xls, xlsx.
    Allowed file types: jpg, pdf, doc, docx, csv, xls, xlsx
  • Accepted file types: jpg, pdf, doc, docx, csv, xls, xlsx.
    Allowed file types: jpg, pdf, doc, docx, csv, xls, xlsx
  • Accepted file types: jpg, pdf, doc, docx, csv, xls, xlsx.
    Allowed file types: jpg, pdf, doc, docx, csv, xls, xlsx
  • Accepted file types: jpg, pdf, doc, docx, csv, xls, xlsx.
    Allowed file types: jpg, pdf, doc, docx, csv, xls, xlsx
  • Accepted file types: jpg, pdf, doc, docx, csv, xls, xlsx.
    Allowed file types: jpg, pdf, doc, docx, csv, xls, xlsx
  • Compliance Agreement:

  • •The funds will be used only for the intended purpose of this request and will not be used in violation of any State or Federal Laws. No third party reimbursement will take place for any services rendered during the medical mission trip.

    •No product(s) will be sold during the medical mission trip.

    •All unused product will be returned to Globus Medical, Inc.

    •No Globus employee implicitly or explicitly offered a contribution to induce the Recipient, its personnel, or me to purchase, use, order, or recommend Globus products or to reward prior purchases, uses, orders, or recommendations of Globus products.

    •The funds awarded will not be used in violation of any healthcare code of ethics.

    •Globus Medical reserves the right to request the return of award at any time upon failure to comply with procedures and legal regulations.

    •A post trip report will be submitted within 30 days of your return.

    •All information included on and documentation attached to this request form by the Requestor and/ or Recipient is accurate.