Program OTM Form

Program OTM Form

Date

Category *

(Select Category)

Nominee's Organization *

Nominee (Person in Charge) *

First

Last

Address *

Address Line 1

City

State

ZIP code

Phone *

UCI Email *

Nominee's Organization *

Nominee *

First

Last

Address *

Address Line 1

City

State

ZIP code

Phone *

UCI Email *

Program Information

Program Title *

Target Population (in numbers) *

Number of People in Attendance *

Program Title *

Number of People Needed to Organize *

Time Needed to Organize *

Date(s) of Program *

Cost of Program *

Origin of Program *

Word Count (200 Maximum)

Please give a short description of program *

Word Count (250-400 Words)

Goals of Program *

Word Count (200 Maximum)

Positive and Lasting Effects of the Program *

Word Count (200 Maximum)

Short Evaluation of the Program *

Word Count (200 Maximum)

How could this program be adapted to other campuses? * *

Word Count (200 Maximum)

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Program Information

RHA serves the three undergraduate communities working to develop a sense of belonging and leadership