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Returning 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
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) *
Do you receive funding from other sources?
How many DMSS provided gifts would you like for your events? (Total) *
Your answer
Please send the IG Report for the Past Year and Present Year Annual Budget to vp.finance.dmss@gmail.com. *
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