AMA Section Involvement Grant Application

AMA Section Involvement Grant Application
General Information
First Name *
Last Name *
School Email Address *
example@example.edu
Mobile Number *

Area Code Phone Number
School Information
State *
Select the school in Alabama where you are enrolled. *
Select the school in Alaska where you are enrolled. *
Select the school in Arizona where you are enrolled. *
Select the school in Arkansas where you are enrolled. *
Select the school in California where you are enrolled. *
Select the school in Colorado where you are enrolled. *
Select the school in Connecticut where you are enrolled. *
Select the school in District of Columbia where you are enrolled. *
Select the school in Florida where you are enrolled. *
Select the school in Georgia where you are enrolled. *
Select the school in Hawaii where you are enrolled. *
Select the school in Idaho where you are enrolled. *
Select the school in Illinois where you are enrolled. *
Select the school in Indiana where you are enrolled. *
Select the school in Iowa where you are enrolled. *
Select the school in Kansas where you are enrolled. *
Select the school in Kentucky where you are enrolled. *
Select the school in Louisiana where you are enrolled. *
Select the school in Maine where you are enrolled. *
Select the school in Maryland where you are enrolled. *
Select the school in Massachusetts where you are enrolled. *
Select the school in Michigan where you are enrolled. *
Select the school in Minnesota where you are enrolled. *
Select the school in Mississippi where you are enrolled. *
Select the school in Missouri where you are enrolled. *
Select the school in Montana where you are enrolled. *
Select the school in Nebraska where you are enrolled. *
Select the school in Nevada where you are enrolled. *
Select the school in New Hampshire where you are enrolled. *
Select the school in New Hampshire where you are enrolled. *
Select the school in New Mexico where you are enrolled. *
Select the school in New York where you are enrolled. *
Select the school in North Carolina where you are enrolled. *
Select the school in North Dakota where you are enrolled. *
Select the school in Ohio where you are enrolled. *
Select the school in Oklahoma where you are enrolled. *
Select the school in Oregon where you are enrolled. *
Select the school in Pennsylvania where you are enrolled. *
Select the school in Puerto Rico where you are enrolled. *
Select the school in Rhode Island where you are enrolled. *
Select the school in South Carolina where you are enrolled. *
Select the school in Tennessee where you are enrolled. *
Select the school in Texas where you are enrolled. *
Select the school in Utah where you are enrolled. *
Select the school in Vermont where you are enrolled. *
Select the school in Virginia where you are enrolled. *
Select the school in Washington where you are enrolled. *
Select the school in West Virginia where you are enrolled. *
Select the school in Wisconsin where you are enrolled. *
Select the school in Wyoming where you are enrolled. *
Year *
Medical School Contacts
Name of Section President *
Section President's email address *
example@example.com
Name of Outreach Leader/Recruiter *
Outreach Leader/Recruiter's email address *
example@example.com
Name/Title of Advisor *
Advisor's email address *
example@example.com
Activity Details
Type *
Event Name *
Date of event or Start date of activity/project *

Month Day Year
Date
Location *
Please provide a detailed description: *
Are there any guest speakers participating? *

Yes No
List guest speakers and their titles. *
Are you collaborating with any other clubs or organizations at your school or within your community? *

Yes No
Name and describe the other clubs or organizations with whom you'll be collaborating. *
Expected Audience
How many faculty members/volunteers will participate? *
How many student members will participate? *
How many student non-members will be invited to participate? *
Expense Details
List and describe all anticipated expenses with amounts if possible. *
List any other organizations that you have requested funding from or confirmed funding from for this activity. *
i.e., state/county medical societies, alumni associations, etc.
Describe the follow up with attendees, specifically non-members,from this event. Please be sure to track attendees with a sign-in sheet, as that is needed in the Recap. *
Mailing Information for Grant Payment

The AMA pays out an approved grant via check, made payable to the school you attend. Please specify where and to whom the check will be posted.
*

Addressee Name

Street or PO Box Address

City State

Zip Code
Thank you for completing an AMA Section Involvement Grant (SIG) Application. We will review the application and respond within 14 days. Please save this email as confirmation. We recommend you share your activity information with your advisor and state/county medical society contacts. If you have any questions, please contact MSSIG@ama-assn.org.
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AMA Section Involvement Grant Application

General Information

School Information

Medical School Contacts

Activity Details

Expected Audience

Expense Details

Mailing Information for Grant Payment