Program Proposal Form
Viking Values and Learning Outcomes
Name
*
Chosen Name (First Name)
Last Name
Email
*
Building
*
Please Select
Atlantic Hall
Bowditch Hall
Forten Hall
Marsh Hall
Peabody Hall
What type of program is this?
*
Solo ACCESS Program
Program Partner ACCESS Program
Half/Tri Staff Social Program
Take To Program
Summer Program
Door to Door Program
Faculty-In-Residence
Program Partner Name
*
(Chosen Name) First Name
Last Name
Program Partner Email
*
Please type in who all Half/Tri Staff Program Partners are
*
0/0
Program Title
*
Date of Program
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Program
*
Hour Minutes
AM
PM
AM/PM Option
Location of Program
*
Max amount of residents this event is intended to serve
*
Type how many residents attended this event
ACCESS Model Viking Value
*
Academics
Community
Self Exploration
Social Justice
Wellness
ACCESS Model Viking Learning outcome
*
Awareness (Think)
Understand (Own)
Act (Do)
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Program Outline and Goals
Program Outline
*
Summarize the program here
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Expanded Goal
*
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Program Preparation
Program Partner Responsibilities
*
List everyone's responsibilities here
0/0
Each Half/Tri Staff program partner's Responsibility
*
List everyone's responsibilities here
0/0
Supplies Needed Summary
*
List all the supplies and quantities that you will be utilizing in this program, type N/A if there are no supplies needed
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Campus Connections
*
List all the campus partners you will work with and your outreach plan, type N/A if there are no campus connections needed for the program
0/0
Advertising Plan
*
Describe how you or your group intend to get the word out for this event
0/0
Setup/Reservation Plan
*
If this program needs reservations or setup from Student Life (IE: MLK Room, Quad, Vets). Please note here and give full details of the setup needed. Type N/A if no outside the hall space is needed.
0/0
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