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T.R. Reid in Del Mar Funding Application
Application to receive funding to go see A Conversation with T.R. Reid, author of The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. The event will take place Monday April 30th from 5pm to 8pm at AMN Healthcare in Del Mar. $25 through April 23rd, $30 after the 23rd and day of event. For more information, please see the flyer:
https://docs.google.com/open?id=18JCPPwP_qJOQRuvWtSyHDL-y8gbwvdPSr04-H5LJyDzTP8iv2Mdgd1N36-Bs
Funding provided by the Student Sustainability Collective:
http://studentsustainability.ucsd.edu/
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Deadline is Friday April 28th
You will be notified by Saturday April 29th if you will receive funding from the SSC
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Please indicate if you are part of any student organizations on campus
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What do you hope to gain from attending the event?
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Are you interested in joining UCSD's Coalition for Single Payer Health Care?
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How do you intend to be involved with the Coalition for Single Payer Health Care?
Please explain how will you apply what you have learned at this event to the Coalition.
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Do you need a ride to Del Mar for the event?
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Can you provide rides to Del Mar for the event?
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