Statistics Reporting Form

Type of Instruction (required)

Title of Workshop, Outreach, or Course (if known)

Department

Course Instructor (Last, First)

Date of Session

Date
/
/

Time of Session

Time
:

Length of Session

Time spent preparing

Number of Students

Location of Session

Type of Class

Please record anything else about the session that you would like to have noted for official/statistical purposes.

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