Community Connection Report Form
RA Name
*
First Name
Last Name
Student Name
*
First Name
Last Name
Residence Hall
*
Anderson
Jorgenson
Rimview
Widenhouse
Room #
*
Date of Connection
*
-
Month
-
Day
Year
Date
Topics of Conversation
*
Notes to follow up on with Pro Staff and/or student
*
Connection Attempt Log (if no connection was made) - 3 different attempts required (date, time, attempt method)
Submit
Should be Empty: