CEHD Community Engagement Form

College of Education and Human Development

CEHD Community Engagement Form

Please complete and submit this form during the semester of occurrence of any community activities on behalf of the College of Education and Human Development (please do not include clinical experiences, internships or field experiences). The purpose of this form is for record keeping, reporting and highlighting the contributions of faculty, staff and �鶹��ýs to our community. Any on-going activities require one submission, please indicate the activity is on-going.

First name (required)

Last name (required)

Department, office or center (required)

Please specify

Type of activity/event (required)

Please describe the activity

Date of activity/event (required)

Start time of activity/event (required)

End time of activity/event (required)

Location of activity/event (required)

Number of CEHD �鶹��ýs involved (required)

Number of faculty and staff involved (required)

Benefits to community (required)

Benefits to CEHD �鶹��ýs (required)

Any additional information?