Burrell College of Osteopathic Medicine Forms

Name of Student Organization:*

Month of Activity:*

Current Faculty Advisor:*

List of all Current Officers and Titles:*

Please include yourself.

Name of Member Completing Form:*

Member Title:

Member Email:

Please provide a description below of all student organization activity that took place during the month indicated above.

Meetings Held:

(include dates, location and number of participants)

Social Events:

(include dates, descriptions and attendance)

Educational Events:

(list workshops/seminars that the chapter sponsored or attended)

Community Service Events:

(include dates, location and number of participants)

DEI Initiatives/Events:

(include dates, location and number of participants)

Fundraisers:

(date, purpose/reason, include recipient organization, amount raised, etc.)

Please upload any supporting documentation:

Drop files here or

Accepted file types: png, pdf, jpg, jpeg, word, doc, Max. file size: 8 MB.

(photos, flyers, articles, presentations, etc.)”

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Please upload any supporting documentation:

Accepted file types: png, pdf, jpg, jpeg, word, doc, Max. file size: 8 MB.

(photos, flyers, articles, presentations, etc.)”