New Chapter Application

If you are interested in creating a new MEDLIFE student chapter at your school please fill out this application!

Are you interested in Global Health? Global Inequality? MEDLIFE is a network of students across the USA that are committed to helping poor families get themselves out of poverty. We believe that all poor families deserve access to MEDs -Medicine, Education and community Development (micro-credit) and to that end we commit our resources, time, efforts and networking ability to bring MEDs to poor families everywhere.
   

Name of College or University: *

Your name: *

Email : *

Email address must be a university associated email to start a new chapter.

Why are you interested in starting a MEDLIFE chapter at your school?: *

How many hours a week will you commit to getting your new MEDLIFE chapter off the ground? : *

What about MEDLIFE's model (Medicine, Education and Development) do you believe is most important to poverty alleviation?: *

Who were you referred by (optional)?:

Example: John Smith at Dartmouth suggested I start a chapter at my school.

What code is in the image?: *

Enter the characters (without spaces) shown in the image.