!"#$%&"'!#((%))'*&$'!#++,-"'.'!!/'012'.'342516750081' 6.19.1240'
Please fill out the form to provide documentation for students attending orientations,
workshops, events or other follow up activity for academic programs and student services. If
all the students are enrolled in one course, please indicate the course name and section
number below; you do not need to fill out individual IDs and names.
Event Program
Date of Service Facilitator
Individual Student Contact (list ID/name below) Group (list IDs/names below)
Course name (if applicable) Section #
Student ID Student Name
Please save and email to westexpressway@wlac.edu or drop off in SSB 420.
Facilitator Signature
Student Success and Support Program
Department / Program / Orientation / Workshop / Event / Follow Up
click to sign
click to edit