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Title of Activity    

FICE Code     

Department                 

Institutional Role 
(1 = sponsor or offeror, 2 = host)

County  Code         

Meeting Date(s)                    
for e.g. (1/2/00 to 1/23/00) 

Fiscal Year   
for e.g. (1999-00)

Meeting Time(s)                       
for e.g. (2pm - 3pm)

Total Contact Hrs. 
(right justified)

Audience Served             

# of Registrants   
(right justified)

Location (Bldg. and Room Number)

CEU's Awarded    Yes        No

Coordinator of Activity  

SIC Code                                         

CIP Code 

                                                     

 

PLEASE SUBMIT A  COPY OF FLIER/BROCHURE AND OTHER DOCUMENTS  
TO MRS. BARBARA JONES IN THE CENTER FOR CONTINUING EDUCATION.  
CALL EXT.  1227 IF YOU HAVE QUESTIONS ABOUT THIS FORM.

                   
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Last Updated: 08/21/07 12:57 PM
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