Today's Date (dd/mm/yyyy): Student Organization: Contact Individual: Telephone Number:
Email Address:
Mailing Address:
Amount of Grant Received:
Name of Event:
Date of Event:
Location of Event:
Number of Students Participated:
Event Website (if applicable):
Description of Event
What was the purpose/goal of the event?
What are some highlights from the event?
How has the event been beneficial to you or your group?
How has the event had an impact on you or your group? (Quote from your personal experience)
Additional comments:
I,, hereby authorize Memorial University to use the photographs, quotes and information submitted, from the event. I authorize Memorial University and their assigns and transferees to use the same, including use with my name or no name. They may use this material in the form taken or in any other format, with intentional or unintentional alterations, and use for the purposes of illustration, publicity, advertising, promotion, and/or publication of any product or service for any period of time.
I accept the above declaration. I do not accept the above declaration.
Date of declaration:
