Social Activity Funding Application

Contact Person(Required)

First Last

Email(Required)

Phone(Required)

Medical School, Campus and/or Location(Required)

Class or Group(Required)

Activity Name(Required)

Proposed Date(Required)

What is the purpose of the initiative/activity?(Required)

What is the desired impact?(Required)

What is the amount of financial support requested?(Required)

Breakdown of costs (if applicable)

For more information, please contact Jennifer Scott Harris, Practice Facilitator – Student & Resident Engagement, at jscottharris@nbms.nb.ca or (506) 871-8904.