Program Planning Form

Summer Housing

Staff Member Last Name:
Staff Member First Name:
Staff Member Position:
Staff Member Area:
Date of Program (format: MM/DD/YYYY):
Program Title:
Program Presenter:
Was a faculty member present?:
First Faculty Member:
Second Faculty Member:
Third Faculty Member:
Thank you note sent to presenter(s)?:	NoYes
Total Cost of the Program (format: $10.10):
How much of total cost is from your specific budget? (Format: $10.10):
Total Attendance of the Program:
When did the program occur?:
Did this program occur before or after 9pm?:
What type of program was this?:
Was this program active or passive? Bulletin board, flyer campaign, newsletter, condom boxes, etc.):
What Learning Outcomes were addressed? (select all that apply):
How would you rate the success of this program? :
How was the program? If it went well, why? If it did not, how could it be improved?:
What requirements do you think you fulfilled? :