Internal Medicine Interest Group Sponsorship Program Application

Thank you for your interest in the ACP IMIG Sponsorship Program! The early bird application deadline is June 1, 2016. View the IMIG Program Timeline for more information.

To complete this application, you will be required to provide information on your school and your planned activities for this year. For ideas and activities, please see the Internal Medicine Interest Group Resource Guide: www.acponline.org/imigresourceguide. Please e-mail any questions to imig@acponline.org.

* Required field

Please note: If your school has multiple campuses, the sponsorship will be divided among all of the locations that apply for funding. The maximum amount any school can receive per academic year is $1,000.
Student Leader Information
2016-2017 Student Leader: IMIG Student Leaders must be ACP Medical Student Members in order for your school to receive funding. Medical Student membership is free. Students can join online. Please fill in ACP numbers for all student leaders to prevent delays in your application.
Additional Student Leaders
NameACP NumberE-mail
Faculty Information
Faculty Advisor
Please list the information on the physician faculty member who provides guidance and support to your IMIG.
Department of Medicine/Internal Medicine Chair
Please provide the name and contact information for the Chair of Medicine at your institution.
Funding and Materials Mailing Information
Checks must be made payable to a club bank account or an institution, they cannot be made payable to an individual. Please confirm payee with your school's accounting office before submitting to prevent delays in your application.
There is a $35 fee for lost/reissued checks.

Shipping Address for Check:

Shipping Address for Materials:

Provide Information about the ACP-Sponsored IMIG Activities
Prepare and Submit IMIG Bylaws
If you have never participated in this sponsorship program before, please upload a completed copy of the group’s bylaws. It is only necessary to submit a copy of your bylaws if you are a new participant to the IMIG Sponsorship Program, or if you've changed bylaws.
Files must be less than 8 MB.
Allowed file types: pdf doc docx.