Well-Being Activity Proposal

Well-Being Activity Proposal

Use this form to propose a well-being idea for MD and MSPA students at Stanford Medicine. OMSW will review your submission, request clarification, and may contact you to present formally. Direct questions about the form to Margaret Govea (govea@stanford.edu). Thank you for your interest in student wellness at Stanford Medicine.

Note that this form is for use by Stanford Medicine MD and MSPA students. OMSW sponsors substance free activities.

Your Full Name*

Stanford Email*

Your Training Program*

Select or enter value

Your Curriculum Phase*

Select or enter value

Activity Name

This can change but give us something to start with.

Activity Objectives*

Audience*

Who is the target audience? Is this for pre-clinical, clinical, MD, MSPA or all students?

Activity Description*

Describe how it will promote student wellness (1-2 brief paragraphs).

Proposed Location

Activity Timing*

What is the timing (quarter, month, weekday, hour...)? Is this a one-time or recurring event? Is there a place this should occur in the school curriculum?

Collaborators/Partners*

Who would you like to partner with to launch this activity? What campus units, student groups or other affiliate groups might support this activity?

What help are you requesting from OMSW?*

Are you including a food budget?*

Select or enter value

Budget Proposal*

Describe your anticipated expenses and other sources of funding to cover expenses.

Comments

What else do you want to tell us about your proposed activity?

Other Student Planners

Full Names & Email Addresses

Send me a copy of my responses

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