1
DE LA SALLE HEALTH SCIENCES INSTITUTE
OFFICE of STUDENT SERVICES
DATE month day year
NAME of ORGANIZATION COLLEGE TITLE of ACTIVITY ACTIVITY VENUE ACTIVITY DATE ACTUAL TIME STARTED NATURE of ACTIVITY BRIEF DESCRIPTION of ACTIVITY OBJECTIVES of ACTIVITY 1 2 Officers and/or members involved in planning & executing activity NAME & YEAR LEVEL POSITION ROLE
ACTIVITY TIME ACTUAL TIME ENDED
TOTAL NUMBER of PARTICIPANTS NUMBER of MALES YEAR LEVEL I
II
NUMBER of FEMALES III
IV
HOW MANY are FIRST TIME PARTICIPANTS of the ACTIVITY? MALES FEMALES YEAR LEVEL I II HOW MANY HAVE ATTENDED THIS ACTIVITY BEFORE? MALES FEMALES YEAR LEVEL I II HOW MANY WOULD ATTEND A SIMILAR ACTIVITY AGAIN? MALES FEMALES YEAR LEVEL I II
III
IV
III
IV
HOW MANY WOULD NOT ATTEND A SIMILAR ACTIVITY IN THE FUTURE? MALES FEMALES YEAR LEVEL I II III REASONS WHY NOT
IV
RECOMMENDATIONS/SUGGESTIONS for IMPROVEMENT 1. 2. PREPARED BY: <NAME/POSITION/ORG> NOTED BY: <ORG PRESIDENT> ENDORSED BY: <FACULTY ADVISER>
STUDENT ACTIVITIES: ACTIVITY REPORT
III
IV