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AMSA's Local Project Submission Form
CONTACT INFORMATION
Chapter:
Select a Chapter
All Saints University
American International Medical University
American International SOM
American University of Antigua COM
American University of the Caribbean SOM
Ankara University FOM
Ben Gurion University Medical School for International Health
Central America Health Sciences University Belize Medical College
Flinders University SOM
Hacettepe University FOM
International American University COM
International University of the Health Sciences
Istanbul University Cerrahpasa Medical School
Kigezi International SOM
King Edward Medical University
Medical University of Lublin
Medical University of Silesia
Medical University of the Americas-Belize
Medical University of the Americas-Nevis
National Defense Medical Center
National University of Rwanda
Poznan University of Medical Sciences
Ross University SOM
Royal College of Surgeons in Ireland
SABA University SOM
Spartan Health Sciences University SOM
St Matthews University SOM
St. Christopher Iba Mar Diop COM
St. George's University SOM
St. James SOM
St. Luke SOM
St. Martinus University FOM
Tel Aviv University Sackler FOM
Trinity SOM
Universidad Autónoma de Guadalajara SOM
Universidad Central del Este
Universidad de Monterrey
Universidad Iberoamericana SOM
University College Dublin SOM & Medical Sciences
University of Balamand FOM & Medical Sciences
University of Dublin Trinity College SOM
University of Health Sciences Antigua
University of Sint Eustatius SOM
University of Sydney FOM
University of the West Indies Faculty of Medical Sciences SOM
Weill Cornell Medical College in Qatar
Windsor University SOM
Xavier University SOM Bonaire
Project coordinator:
Coordinator's email:
PROJECT DESCRIPTION
Project Type(s)
Select all that apply.
Community Service
Fundraiser
School Service
Social Event
Speaker
Recruitment
Rally
Lobby Event
Other
Project title:
Date of completion:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2009
2008
Summary of project:
Content area:
Select all that apply.
Business of Medicine
Child and Adolescent Health
Community and Environmental Health
Complementary/Alternative Medicine
Creative Expression
Culture of Medicine
Death and Dying
Disabilities
Disparities
Diversity in Medicine
Education
Election Reform
Environmental Health
Family Violence
Gender and Sexuality
Geriatrics
Global
Grassroots Leadership
Health Care for All
Health Fair
HIV/AIDS
Human Rights
Humanistic Medicine
LGBT Health
LGBT People in Medicine
Medical Specialties
Mental Health
Military Medicine
Minority Affairs
National Primary Care Week
Naturopathic Medicine
Neurology
Osteopathic Medicine
PharmFree
PDAs
Pharmaceutical Issues
Policy
Primary Care
Preventive Medicine
Professionalism
Race, Ethnicity and Culture in Health
Resident Work Hours
Student Debt
Student Life
Student-Run Clinic
Substance Abuse
Surgery
Wellness/Well-Being
Womens Health
Other
Number of attendees:
People
Duration of event:
Hours
Round to the nearest hour and do not include text in your answer
PROJECT PLANNING
Project coordinator roles:
Total coordinator hours:
Hours
Round to the nearest hour and do not include text in your answer
FUNDING
Total cost of project:
How was the project funded?
Select all that apply.
Local chapter funds
School funds
AMSA grant
Other grant (clarify in funding breakdown box below)
Donation
Admission/participant charge
Please describe the breakdown of your sources of funding and/or donations:
ADVERTISING
How was the project advertised? Did it work?
PROJECT EVALUATION
How would you rate the success of your project?
- Select one -
1 unsuccessful
2
3
4
5 very successful
Lessons & suggestions: What could have been done to improve the project? What should others know to replicate this?
ADDITIONAL COMMENTS
Any additional comments that may benefit a chapter in completing a similar project would be greatly appreciated.