University of Illinois College of Medicine at Peoria



Name of Group     

Academic Year: 20      - 20     

University of Illinois College of Medicine at Peoria

Interest Group Registration and Financial Needs Estimate

Purpose of Group:      

Officers/Leadership (at least THREE officers are required for registration):

Officers must be enrolled both semesters during the Academic Year indicated above.

|Name |Office |Class |Email address |

|      |President (required) | | |

|      |Treasurer (required) | | |

|      |       (required) | | |

| | | | |

Faculty Advisor: _      Advisor’s Dept:     

Briefly list the Activities & Projects planned for the coming year. Indicate projected dates, if known.

     

Estimate the group’s expenses for the academic year.

|Describe Proposed or Completed Activity or Purchase |Estimated Cost |

|      |      |

|      |      |

| |      |

|TOTAL Anticipated Expenses |      |

Estimate anticipated sources of income other than Student Fee funding (e.g. fund raisers, dues, grants).

|Source of Funding |Estimated Amount |

|      |      |

|      |      |

|TOTAL Outside Funding |      |

Form Submitted by (signature):       Date:      

Name Printed      Contact info:     

To ensure eligibility for consideration for funding for the academic year, this application should be submitted to the Student Affairs Office by the Monday before the third Wednesday in August of the Academic Year for which the application is made. Funding may not be available for applications received after that date.

-----------------------

Student Affairs Group Registration Approval: ______________________________ Date: _________________

Budget Approval: __________________________ Amount Allocated: ________________ Date: ____________

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