MD Student Organization Intent to Organize
Group
Name of organization
Location
Please select...
Hershey
University Park
Both
Do you intend to apply for funding from the HPSA?
Yes
No
Do you intend to apply for additional funding/recognition from other student assemblies or departments?
Yes
No
Additional funding can be applied for only if the organization contains members from a graduate program, PA program or the nursing program.
Please select the group(s) you intend to apply to for additional funding
Please select...
Department
Graduate Student Assembly
Nursing Student Assembly
Physician Assistant Student Assembly
Other
Please select which category you believe best describes the overall mission/purpose for your organization.
Find definitions here
.
Please select...
Academic/Professional
Honor Societies
International/Multicultural
Media/Publication
Music/Performing Arts
National/Regional/State Association Affiliate
Philanthropic
Political
Religious/Spiritual
Special Interest
Service
Sport/Physical Activity
Student Council/Governance
Temporary
University Affiliate
Other
Category choice subject to review by the Office of Student Affairs
Description or purpose of group
What kinds of programs and services will this new organization offer that are different from any other recognized student organization?
Contact
First Name
Last Name
Email address
Phone Number
Contact Information