Continuing Education Non-Credit Activity Report

Person on campus responsible for activity:
Name(s) of Instructor(s):
Program's primary topic:

Reporting institution's code:
Record code:
Date(s) of activity (by school year):
Activity focus:
Clock hour length: (total number of clock hours of activity)
Activity Format:
Number of Participants:
City:
Name of other city:
County:
Name of other county:
State:
Name of other state:
Country:
Name of other country:
Type of group (that requested or sponsored this activity):
Title of activity: (actual name or readable abbreviation - 40 character limit)