SIG Program Application Form

Questions can be directed to sigs.mmsa@gmail.com. Applications are due December 14th, 2020 at 2359 CST. Application guidelines can be found here.

Contact Information
Initiative Name*
Primary Applicant Name*
First Last
Co Applicant Name
First Last
Primary Applicant Graduating Year*
Contact Email*
Contact Phone Number*
Additional Information
Details regarding your initiative will be ignored in this section.
Initiative Details
Please summarize the initiative including its objective(s) and how it will accomplish said objective.*
Please describe how the initiative will enhance the experience of Manitoba medical students with respect to their education, wellbeing, or otherwise.*
Please describe how the initiative will enhance your local, provincial, and/or national community.*
Please describe the initiative’s proposed timeline from start to completion, including steps already taken.*
Budget*
Add lines as necessary. A maximum of $1000.00 may be requested.
Item Description Timing of Cost Cost ($) Other Funding ($) Requested Funding ($)
*
Total Cost ($) Total Other Funding ($) Total Requested Funding ($)
Declaration*
I hereby acknowledge that
1. 1. I am a medical student at the Max Rady College of Medicine, University of Manitoba.
2. 2. My initiative adheres to all eligibility criteria and other guidelines outlined in the Student Initiative Grants Program Guidelines
3. 3. The information provided below is accurate to the best of my knowledge.
I have read and acknowledge the the terms above.

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Item	Description	Timing of Cost	Cost ($)	Other Funding ($)	Requested Funding ($)

SIG Program Application Form

Contact Information

Initiative Details

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