CABL Report Form

Semester *

Fall

Spring

Year (YYYY) *

CABL Leader Name *

Phone Number *

Email *

College/University *

Address *

Address

City

State/Province

Zip/Postal

Country

This is where the scholarship check will be sent.

Activity #1

Name of program/activity *

Activity focus *

Emotional/mental health

Spiritual health

Physical health

Social health

Number of participants *

Cost of program ($) *

Objectives/outcomes you expected to see *

What organizations/departments did you partner with? *

What was your role in planning/doing the activity? *

How did you advertise?

What can you do next time to improve the acIvity? *

Activity #2

Name of program/activity

Activity focus

Emotional/mental health

Spiritual health

Physical health

Social health

Number of participants

Cost of program ($)

Objectives/outcomes you expected to see

What organizations/departments did you partner with?

What was your role in planning/doing the activity?

How did you advertise?

What can you do next time to improve the activity?

Signatures

I verified that the information provided on this form is true and accurate. *

Yes

Print name of CABL student leader. *

Name of faculty sponsor *

Faculty sponsor email address *

Date *