Cultural Event

Report Form
Course

Event

Date

Event Number

First Name

Last Name

Instructor
Faculty Witness Name

Faculty Witness Signature

Name of Event: ...........................................................................................................

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1. Attend the event.
2. Write legibly a 250 word essay about what you have heard. You may
continue on the back of this form.
3. Complete the PPI Assessment at the bottom of this form.

4. Have a faculty member who is in the room sign this form to attest to
the fact you were here and wrote the essay..
5. PRINT the faculty members name to the left of his/her signature.
6. Submit this form to your instructor in your next class.

Essay (250 words) Describe and evaluate what you have heard and experienced today. Continue on the back if needed.
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Assessment: Assess the value of your experience today by giving ideas about your own personal benefit from it.

Positive:

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Reason it is positive: ......................................................................................................................................................................

Potential for Growth or Improvement: ...............................................................................................................................................

Ways to accomplish this: ...............................................................................................................................................................

Insight:..................................................................................................................................................................................................
Why is this important? ...................................................................................................................................................................
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