Co-Curricular Requirements Event Proposal Form

Co-Curricular Requirements Event Proposal

Complete this form to inquire whether or not a non-COPHS sponsored event can count as a co-curricular requirement. This form must be submitted online (5) business days before the day of the event for approval.

Name*
First Last
T-Number*
Phone*
School Email*
Personal Email*
Domain Dropdown List*
Professional Year*
Name of the Event*
On Site Preceptor*
Event Date/*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
Hosted By*
Description of Event*
Objectives of Event (refer to CAPE in Blackboard if needed)*
File
Signature*