Student Interest Group Registration 2023-2024

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The Office of Student Affairs in conjunction with the Student Senate requires all student groups to be registered independently from applying for funding. This allows students who wish to form a student group but do not require funding to be recognized by AMS in an official capacity. Should you have any questions regarding this form, please contact the Office of Student Affairs (medstudentaffairs@brown.edu).

Name of group *

Is this a new group? *

List all student leaders and email addresses *

Enter in this format: "Roxanne Vrees (roxanne_vrees@brown.edu), Kelly Whalen (kelly_whalen@brown.edu)..."

Group treasurer and email (if applicable):

Required if the group will be applying for PACC or Senate funding.

Faculty advisor name and email (if applicable):

If you have a faculty advisor or advisors, please list them here. The Office of Student Affairs may request that certain student groups (for example, any group planning to work in the community holding health fairs, tutoring/mentoring programs, etc.) obtain a faculty advisor. All specialty interest groups should have an advisor in the department of that specialty.

Community site liaison name and email (if applicable):

This is required for any group planning to work in the community (examples include health fairs and tutoring or mentoring programs). This may be the same person as the faculty advisor.

Community engagement student leader name and email (if applicable):

This is required for any group planning to work in the community (examples include health fairs and tutoring or mentoring programs). This leader will ensure along with the Offices of Student Affairs and Diversity/Multicultural Affairs that all work in the community is being done in a responsible fashion.

Group categorization *

Advocacy/Service Group (involve community work, engagement, or advocacy)

Medical Association Representative (chapters of national medical associations, e.g. the AMA)

Student Life Groups (enhance student life outside of medicine)

Specialty Interest Groups (focus on a particular medical specialty)

Description of group *

This description will be posted on the Student Affairs website.

All group leaders must read and abide by the Guidelines for Student Organizations. *

We have read and will abide by the Guidelines for Student Organizations.

Required

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