Student Activities
Name of Student Student ID# E-mail Address Event Date of Event
Type of Event (Choose One)
What did you learn or how did you respond to the program or presentation?
Place a choose the selection that best indicated your response to the educational value of the event you have just attended. Select Excellent Educational Experience Good Educational Experience Poor Educational Experience No Educational Value
By typing my initials below in the box below, I certify that I have attended the event listed above and that I have truthfully respresented my attendance on this form.