Department/Name: _____________________________________________ Submission Date: ___________
Interpersonal Development
Social Responsibility and Diversity
Personal Development
Cognitive and Practical Skills
Intrapersonal Development
Date: ______________________
Time: ______________________
Location: ___________________
1. Program Title: __________________________________________________________________________
2. Is this a collaborative program? Yes No
3. Other departments involved:
4. Anticipated Program Cost: $_________
5. Attendance Goal: __________
6. Program Outcome Goals:
7. How will you know if you were successful in achieving your program goal?
8. Program Outline:
9. In what ways does this program support the domain selected above?
Dean of Students Signature:_______________________________________ Date: __________________
Student Learning Outcomes
Program Proposal Form
Program Evaluation Form
Program Title: _______________________________________________ Program Date: __________
Anticipated Program Cost: $__________ Actual Cost: $__________
Attendance Goal: __________ Actual Attendance: ____________
1. Outcome Goals (Copy from Program Proposal):
2. Did you accomplish your goals? Yes No
3. What did participants learn from this program?
Submission Date: ___________ Department/Name: _____________________________________________
Terms of Acceptance and Signature
I, the applicant for this form, warrant the truthfulness of the information provided above.
Electronic Signature
I understand that by checking this box constitutes a legal signature confirming that I acknowledge and agree to the
above Terms of Acceptance.
Learning Outcomes
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