CAFP-Foundation: FMIG Reimbursement Form
California Family Medicine Interest Groups are eligible for up to $1,000 toward operating costs of FMIG activities with a specific purpose of advancing student interest in family medicine.
All events are possible thanks to funding provided by the California Academy of Family Physicians Foundation and the American Academy of Family Physicians. Please note that unspent funds do NOT rollover into the next academic year.
Complete the following information and submit the required documents for reimbursement.
Today's Date:
Date of Event:
Next Event Date (if available):
FMIG Leader Name
FMIG Leader Email
Medical School
Please select...
California Northstate
California University of Science and Medicine
Loma Linda
Stanford
Touro University
UC Davis
UC Los Angeles
UC Irvine
UC Riverside
UC San Francisco
UC San Diego
USC-Keck
Western University
Other
Number of students attended:
Number of faculty/staff attended:
Event Title:
Please provide a brief description of your event and indicate how it helped to advance student interest in family medicine.
Itemized list of expenses for reimbursement:
Item Description
Cost
Total Cost of All Expenses
Total
Mailing Address
Make Check Payable to:
Address Line 1
Address Line 2
City
State/Province
Postal Code
Copy of Receipts (please submit as a PDF if possible)
Photos from Event
Event Sign-In Sheet (please submit as a PDF if possible)
Your Name:
Your Email
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Contact Information