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New Interest Group Funding Request
Please submit all outstanding DMSS reimbursement requests using this form
Current Academic Term *
Name of Interest Group *
Your answer
Formal mandate (250 words max.) *
Your answer
Description of the Interest Group (to be displayed on the DMSS and Student Affairs websites; 100 words max.) *
Your answer
Executive 1: Name *
Your answer
Executive 1: Email *
Your answer
Executive 1: Graduating Year *
Executive 2: Name *
Your answer
Executive 2: Email *
Your answer
Executive 2: Graduating Year *
Written explanation for why more than two (2) executives needed if applicable.
Your answer
Explanation for circumstances that preclude the IG from obtaining fifteen (15) signatures. This should include reasons why this IG will provide benefit to the student body at Dal Med. *
Your answer
Would your IG like to host a Lifestyles in Medicine Night? *
If not a "Medical Specialty IG," what is the rationale behind hosting a Lifestyles in Medicine Night? (150 words max.)
Your answer
I agree to submit and release pictures of the project for DMSS/DMAA use (sent to vp.finance.dmss@gmail.com) *
How many DMSS provided gifts would you like for your events? (Total) *
Your answer
Please send Signatures of Support AND the IG Annual Budget to vp.finance.dmss@gmail.com. *
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