SGB New Club Proposal

Name of Organization *

Club Website

Is this Organization a Interest Group**?

Yes No

* An Interest Group is defined as a group/club of students who have a interest in a specific medical or scientific area (for instance: radiology, oncology, neuroscience, immunology, etc.). These groups must have a faculty advisor.

Faculty Mentor (Required for Interest Groups) *

Faculty Mentor Email Address (Required for Interest Groups) *

Board Members (must list at least 2 student board members)

Name

Email

Title

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2

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7

Club Mission Statement (to be displayed on OSA website) *

OSA Club Website: http://www.einstein.yu.edu/education/student-affairs/student-activities/involvement/clubs/

Contact Email for OSA Website *

Proposed Events for Current Academic Year

Event

Event description

Estimated cost for event

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2

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15

Any Additional Comments?

E-mail address that all SGB correspondences should be addressed to (including activation of your budget, if your club is approved) *

Einstein E-mail address of club leader submitting proposal *

example@einsteinmed.org

Please note that the SGB will receive your submission after hitting submit, even if you do not see a confirmation screen.

Einstein SGB New Club/Interest Group Proposal Form