Name: ___________________________________________
Event Title:_____________________________________
Event Sponsor: ________________________________________________
Date(s): ________________________________ Time: __________________________
Field Instructor Approval Initial _____________
Counted Time for This Event: _______Hrs.
Total Time Accrued This Year: _______Hrs.
Briefly describe the event.

What did you learn?




What information was helpful?




What are some topics/information that you can share with other students at integrative seminar?




If the same event is offered the next year, will you recommend it to the IAP students? _____ Yes _____ No

Please submit this form to Linda Mertz within 7 days after the event with information on the event (e.g., brochure, program, etc., if applicable). Submit a copy of the form to your field instructor.