May Owen, MD, Outreach Program Report

May Owen, MD, Outreach Program Report
May Owen, MD, Outreach Plan

Thank you for participating in the May Owen, MD, Outreach Grant Program, and for providing female physician-oriented programs and activities to your county.

Please submit this brief report providing the reimbursement form, receipts, attendee list, brief follow up summary, and photos of your event. The grant funding will be provided as a reimbursement. Reimbursement will not exceed the amount approved during the application process. We appreciate your participation and hope you will apply for the grant next year!

Event Name*
Event Date*

MonthDayYear
Date
Event Time*
Event Location*
Type of Event*
Reimbursement Form and Receipts*

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Should include reimbursement form and receipts Cancelof
Attendance Report*

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Should include the full name, email address, and TMA member ID or medical license number for each physician attendee Cancelof

Responses below will help us evaluate the success of the grant and market it in the future:
Brief follow up summary*
Provide a brief overview of your event
Event Photos

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Cancelof
Was the grant criteria easy to understand and the directions easy to follow?
Were the resources, such as sample fliers and emails, helpful to you?
Did the attendees provide positive feedback on the evaluation form?
Would you apply for the May Owen, MD, Outreach Program again in the future?
Additional comments:
Should be Empty: