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RA Name:
RA Email Address:
Floor: (Select) Ground Floor 1st Floor 2nd Floor 3rd Floor 4th Floor 5th Floor 6th Floor
Other RAs Involved:
Program Title:
Date of Program: [None]
Time of Program:
Location of Program:
Did program meet your goals?
Why or why not? How many students attended?
Total cost of program:
Please submit any receipts to the Assistant Director of Residence Life for reimbursement.