MAA Award Thank You Form

Congratulations on receiving an award from the Medical Alumni Association!

Please provide a formal letter of thanks, using the form below. Address your letter to the Medical Alumni Association, and include a little bit of a biography of yourself, your goals, and how this funding will benefit you during your medical studies and your future career in medicine.

Please note, your letter will be provided to the donor who made the award whenever possible. We will contact you upon receipt of this form to arrange payment.

Basic Information

First Name *

Last Name *

Email *

Alternate Email

Student Number *

Year of Graduation *

Campus *St. GeorgeMAM

Is this Award over $500? *YesNo

Social Insurance Number *This is required by C.R.A. for tax purposes.

Current Address

Address *

Apt/Suite/Unit *Please enter your unit number or enter N/A

City *

Province *

Postal Code *

Phone *

Additional comments regarding Basic Information

MAA Award, Bursary or Scholarship

Name of the MAA Award, Bursary or Scholarship *

Amount *

Thank you letter *

I give the Medical Alumni Association permission to use my letter and images for the purpose of promoting the MAA and its activities and programs which may include advertising, promotion, fundraising and marketing.YesNo

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