Post Activity or Community Service Event Evaluation Form

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Host Organization
Name of Activity
Date of Activity Date of Activity / MM / DD YYYY
Organizer's Name Organizer's Name First Last
Organizer's Email
Was the Activity a General Membership Meeting

Was the Activity a General Membership Meeting Yes (please provide summary) No
Description or Purpose of the Activity or meeting agenda
If community service activity, describe the population the activity served
Approximate Number of Patients or Participants Served
Provide a brief description of what went well and any changes for future events
Participant Faculty

Participant Faculty Samuel Bobo Charles Breese Donna Breese Melissa Burmeister Timothy Fincher Will Graham Mary Long Joseph Nosser Samantha Odem Ronald Reed Nicole Rivera Troy Smith Robin Vidal Kris Virga Abby Weldon Dave Weldon Jennifer White Caiyun Jane Yang Whitney Zumwalt