Frequently Asked Questions About Chapter Involvement

Part A - Contact information

* Medical school

*Event coordinator
You must be an AMA member to apply.

Chapter position held by event coordinator

*Event coordinator phone number

*Event coordinator e-mail address

*Exact name of organization to whom check should be made payable
(e.g. Chapter, state/county society, etc. Checks can not be made payable to individuals.)

*Mailing address
Check will be mailed to this address.

* City

* State
Choose a state Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

* ZIP code

*Chapter president
If you are the chapter president, please fill in your name.

Chapter president e-mail address (if available)

*Chapter recruiter
If you are the chapter recruiter, please fill in your name.

Chapter recruiter e-mail address (if available)

Part B – Event description

* Title of project:

* Date of project:
January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2008 2009 2010 2011

*All chapter events funded by Chapter Involvement Grants must augment new member recruitment, member retention, or both recruitment and retention. Please indicate which of the following outcomes your event will accomplish:
Choose an expected outcome Increase new member recruitment Increase member retention/ member involvement Increase both recruitment and retention

*Please briefly describe how your event will increase new member recruitment or member retention/involvement.

*What kind of event are you planning?
Choose one Recruitment and chapter development Community service National Service Project

*Please further classify your event by marking the appropriate box within the appropriate category below.
If your event falls into more than one category, please mark all appropriate boxes. Please refer to the Chapter Involvement Grant guidelines for assistance in classifying your event.

Recruitment and chapter development event
Social event (e.g. “Meet and Greet”)
Presentation about the AMA
Other – Please describe

Community service event
Volunteer work
Health fair
Elementary/high school outreach (e.g. Doctors Back to School event)
Fundraiser
Running race or fun-run
Other – Please describe

National Service Project event
The current MSS national service project is “AMA Healthier Life Steps™ Program.”
Volunteer work
Health fair
Educational event (e.g. lecture)
Other – Please describe

*Please describe your event in 150 or fewer words.
This description may appear on the AMA-MSS Web site.

*Please cite specific MSS or AMA policy that supports this event.
You must use the MSS Digest of Policy Actions or the AMA Policy Compendium. Please include only the policy number and title.

*Anticipated event attendance
Student members

Student non-members

Other (e.g. faculty, undergraduates, general public)

*Event venue (e.g. on-campus site, clinic, park, etc.)

Speaker name(s) and title(s)
If your event will include speakers, please list their names and titles.

*Please list and describe all anticipated expenses associated with your event. Provide actual quoted prices where available.
Please note that per AMA policy, CIG funding can not be used to fund certain event expenses including, but not limited to: travel costs (including gasoline reimbursement, airline, rental cars, etc), alcoholic beverages, door prizes/raffles, charities, guest speakers, t-shirts, community projects that require blood draws, shots, etc.

Please list and describe any additional sources of funding
Please include the names of other organizations and the amounts of funding they will provide. It is highly recommended that chapters seek funding from their state medical societies.

*Please descibe how this event will increase the visibility of the AMA and of your chapter.

*Please descibe how and to whom you will publicize your event before it takes place.

*Please indicate whether you plan to use the AMA name or logo on promotional or other event materials.
In order to use the AMA name or logo on any event materials, you must contact the MSS for approval, which generally takes 1-2 weeks. The AMA can also provide materials for your event - visit the Chapter Resources Center to order materials. Please contact us if you have any questions.
Choose one Yes, we will use the AMA name or logo No, we will not use the AMA name or logo

Part C - Event follow-up

*Please describe how your chapter plans to follow up with this activity in the future and how the AMA will continue to be involved in promoting the topic or issue that was addressed by your event.

*Please describe how your chapter will determine the impact of this event on new member recruitment and/or on member retention and involvement.

Please remember that in order to apply for another grant, you are required to submit the CIG follow-up form within 30 days of your event. Students are also strongly encouraged to forward a copy of this application to the appropriate state medical society staff contact.

If you have any questions, please contact the AMA-MSS.

Thank you for completing the CIG application!