Name of Program

Date of Program

Time of Program

Location of Program

Program Initiated By: (check and fill in name)

RA

AC

SGA RH Committe

ORL

Other

Classification of Program:

Basic Gist of Program:

Number of Residents in Attendance:

Proposed Cost of Program:

Actual Cost of Program:

Did the Program . . .

Meet its expressed purpose? no yes
Go over well with those present? no yes
Involve student planning? no yes
Involve student participation? no yes
Would you recommend this program to another RA? no yes

Resource people (include names and contact information) as well as materials/equipment utilized:

Evaluate the Program and Recommend Changes for Further Use:

This form must be submitted to your AC within a week of the program's completion.