1.	Name of Organization*

2.	Name of the person submitting this form.*

3.	Email address of the person submitting this form.*

4.	What was the date of your program?*
	mm/dd/yyyy

5.	What was the time of your program?*

6.	If your event was co-sponsored by another student organization or campus department, please list them.

7.	What type of program was this event? (please check all that apply)*
	Community Service    Educational    Social    Other, please specify

8.	How many people attended this program?*

9.	Please list the purpose, goals, and outcomes of the program.*