Student Community Engagement Reporting Form
  

Student Community Engagement Reporting Form  

[ Please Fill Out ALL Fields ]
 
  First Name:  
Last Name:  
  Date of Event:
 
 
  Location of Event:
 
  If Other, where?  
Student or Staff Organization / Program / Class Involved:

 
Number of Students Participating:  
Number of Faculty Participating:  
Number of Staff Participating:  
How long (in hours) did this event last?   
  Describe the Event:  
       
     







Office of Student Engagement | 300 Campus Drive, Parkersburg, WV  26104-8647
Phone: (304) 424 - 8309 | Fax: (304) 424 - 8279
© 2011 West Virginia University at Parkersburg.  All rights reserved.  ; Site maintained by IT Services