Outreach Leader Application

Become a Student Outreach Leader Today!

The American Medical Association is offering a leadership opportunity within the AMA local campus section at your school for rising second-year and third-year medical students who exhibit excellent leadership, strong organizational skills and a desire to build their professional network. As a Student Outreach Leader, you will lead AMA membership outreach efforts at your school to strengthen the voice of the AMA and help shape the future of medicine. We provide marketing materials, training, resources and event funding to help you be successful.
First Name *
Last Name*
Are there any other names under which you may be found in AMA systems? (For membership confirmation purposes)*

YesNo
Other names by which you may be found in AMA systems:*
Are you a current AMA Member?*

YesNo
E-mail Address*
Please use the email address tied to your AMA membership account
Mobile Number*
ME#
This unique number is available by logging into your AMA account and accessing your AMA Account Center
Date of Birth*

MonthDayYear
For AMA Membership Validation
MD or DO?*

MDDO
School City*
School State *
Medical School Name*
Campus Type*

Main CampusSatellite
What region is your school located within?*

1234567
In Fall 2024, what school year will you be?*

M1M2M3M4Other
Do you hold a current position with your local AMA section?*

YesNo
Apply / Elected / Rollover*

ApplyElected/ReferralRollover
Are you working with your local AMA chapter at your school to fulfill this position?*

YesNo
Name and Title of staff member on campus who can help you amplify your AMA recruitment message?
(ex. Faculty member, Advisor, Administrator)
Staff Member's Email Address
Optional: Were you referred by a current outreach leader? If so, who?
By submitting this form, I agree that my name and email address may be shared with Medical Student Section (MSS) Governing Council members, MSS region leaders, and other AMA student leaders for engagement and recruitment support.

All Outreach Leaders will be added to a GroupMe for communication between student leaders and the Medical Student Outreach Program. For questions or to opt out, please contact studentops@ama-assn.org or your Student Outreach Manager.
*We process data received about you on the legal basis of AMA’s legitimate interests in providing our services, websites, apps and their functionality to you.
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Become a Student Outreach Leader Today!