PM&R Fair Application

Your Name(Required)

First Last

Your Title/Role(Required)

Your Email(Required)

Name of Your Fair(Required)

Sponsor Site(Required)

Faculty Sponsor(Required)

Sponsor Email(Required)

Planned Date of Fair(Required)

Program Summary

Provide a brief summary of the program and structure of your PM&R Medical Student Fair.

Proposed Budget Attach an Excel spreadsheet with your proposed budget. Up to $750 may be requested from the AAP.

Amount Requested ($)(Required)

Budget(Required)

Drop files here or

Accepted file types: xlsx, Max. file size: 128 MB.

Additional Funding Sources Provide details on additional funding sources and/or the required matching funds for this program. Include the amount for pending and received funds.

We have received or will receive matching funds for the PM&R Fair(Required)

Yes

Description(Required)

Recruitment Plan(Required)

All grant applicants are required to recruit medical students from medical schools in the surrounding area (not just at their own institution). Please provide details on your planned recruitment efforts.

Evaluation(Required)

How will you measure the effectiveness of your activities? What is your criteria for success? How do you plan to follow up with the participants after the Fair to continue to develop their interest in Physiatry?

Name to which grant check should be made payable, if application is approved.(Required)

First Last

Address where grant check should be sent, if application is approved.(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Letter of Support from PM&R Department(Required)

Drop files here or

Max. file size: 128 MB.

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PM&R Fair Application

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