EXEMPLARY PERFORMANCE – EVALUATION/POST-EVENT FORM
Information on Event Funded by IRA
Name of College/Unit:
Certified Activity/Program:
Event Fund
ed:
Place of Event:
Date of Event:
Number of Students Funded:
Number of Students Attending:
Amount Out of Pocket per Student:
Please attach a list of all student's names attending the event.
Ranking at Event (Informational):
Summarize Expenses Funded by IRA
Amount Funded $ _________________
Expenses
Type: Transportation: $ ________________ ________________
Type: Local Transportation: $ ________________ ________________
_______________ Hotel: $_
Per Diem: $___________
_____
Entry
Fees: $________________
________________ Miscellaneous: $
Explain:
Total $________________
Unused Funds $
This form should be completed and returned to Kim Williams (kwilliams@csuchico.edu) within 30
days of completion of project. Funds not used per the allocation approval or not spent must be
returned to the IRA. Please contact IRA at 530-898-6560 for instructions on returning unused funds.
Please write a brief paragraph discussing the event that was funded, the educational impact on the
students attending, and your assessment of the value of participating in the funded event for your
Certified IRA Activity/Program. Print and sign your name and enter the date below.
Activity/Program Director:
Date:
