College/University: __________________________________ State: _______
Sponsoring organization(s): __________________________________________
Contact persons:
Student:
Name: _____________ Email ______________ Phone __________
Faculty/staff advisor (If applicable):
Name: _____________ Email ______________ Phone __________
Topic:
Goal or Objective:
Description of Activity:
(Please attach any supporting material, handouts, etc.)
Estimated Time for Activity: __________________________________________
In your opinion, how effectively did this activity help people become prepared for the remainder of the dialogue and achievement of the goal?
Very effective --- Moderately effective --- Not effective
Any changes you might recommend to make the activity more effective?
