CAFP-Foundation: FMIG Reimbursement Form

California Family Medicine Interest Groups (FMIGs) are eligible for up to $1,400 to support operating costs, activities, and special projects. Funding is made possible by the California Academy of Family Physicians Foundation and the American Academy of Family Physicians.

Please note: Unspent funds do not roll over to the next academic year. Complete the information below and submit the required documents to request reimbursement.

We love highlighting the amazing work of FMIGs! Share your photos and a short write-up, and we may feature your group in our communications.

Today's Date:

Date of Event:

Next Event Date (if available):

FMIG Leader Name

FMIG Leader Email

Medical School

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

Contact Information