Internal Outreach Information Form

Internal Outreach Information Form

Thank you for reporting your outreach event! This form is used to record the impact of Cuesta's campus-wide outreach efforts in our community. We greatly appreciate your support with this effort. This form also serves as an internal outreach request document for Outreach assistance with an event. We request at least one month's notice. For any request needing staff support. Submission of form is not a guarantee of attendance by Cuesta College, but we will do our best to accommodate all requests. If you have any questions, please contact the Outreach, Orientation and Success Activities office at outreach@cuesta.edu or 546-3100 x3147.
Name:*

First NameLast Name
Phone Number:*

AreaPhone Number
Email*
example@example.com
Department or Division:
What is your role on campus?

Outreach & Recruitment StaffCuesta StaffCuesta FacultyOther
Outreach Support Needed*

YesNo
Name of Event:
Event Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date & Time
Event Type
General Population at Event

High School StudentsMiddle School StudentsElementary School StudentsParentsIndividual/FamilyRegional OrganizationCommunity MembersOther
Specific Programs Promoted at Event
(Ex. Engineering, CAFES, CTE. If None, put General.)
Number of Potential Students at the Event?
Record 0; if no students attended.
Number of potential students interacted with at the event?
Record 0, if no students attended.
Total number of people at the event?
Should we attend this event again in the future?

YesNo
If your answer was no, Please state reason below:
Was Spanish translation requested?

YesNo
Was Spanish translation needed?

YesNo
Was Spanish translation provided?

YesNo
Event Flyer (If Applicable):

Browse Files

Cancelof
Additional comments about event or any special request:
Should be Empty: