student-organization-request-for-funds-2008

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					                          Student Organization
                      Request for Additional Funding

Each OFFICIAL Student Organization will receive $500 seed money for annual activities
from VCOM. OFFICIAL Student Organizations may also submit up to three (3) requests
for additional stipends of $500 each to perform service and outreach projects.
Applications must be submitted to the Student Services Assistant by October 31, 2008 to
be considered. All information below must be completed for consideration.

Name of Student Organization: ______________________________________________

Name of President: ________________________ Term Ends: _____________________

Name of Student Coordinator of Project: ______________________________________

Name of Faculty Advisor: _________________________

Name of Project: _________________________________________________________

Location of Project (City, State/Country): _______________________          __________

1.) Please attach a description (100 words or less) of the outreach project you wish to
perform. Include how many people will be served and how many students will
participate.

2.) What is the #1 purpose for doing this project (choose only one):
____ Gaining experience for medical students
____ Serving underserved patients
____ Social
____ Outreach to the community/publicity for VCOM
____ Other: __________________________________

3.) What is the #2 purpose for doing this project (choose only one):
____ Gaining experience for medical students
____ Serving underserved patients
____ Social
____ Outreach to the community/publicity for VCOM
____ Other: __________________________________

4.) Please check one:
 _______ This is a project our organization has done before and we plan to do it annually
or more often than annually.
_______ This is a project we have done but are making substantive changes to what has
been done in the past. Specify these changes: ________________________________

_______ This is a new project.

5.) If awarded $500 for this project, how will the funds be used? All funds may go
toward the project or split between the project costs and other activities for the club. If
so, specify what other club activities this money will be used for: __________________

_______________________________________________________________________

________________________________________________________________________

________________________________________________________________________



_________________________________________
President or Student Coordinating Project Name


_________________________________________                    __________
President or Student Coordinating Project Signature             Date

_________________________________________
Faculty Advisor Name

__________________________________________                   ___________
Faculty Advisor Signature                                       Date



   Return this form to Student Service Assistant by October 31, 2008

				
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