REAL Tide Tagged Experience Request

General Information

Contact Information:

First Name:

Last Name:

Position/Title:

Department/Program:

Email:

Phone:

Experience Options:

Please select the experience type:

required

Event/Program

Organization Involvement/Campus Employment/Leadership Role

Self-Reported or External Experience

Please select the Engagement Wave(s) that most closely matches your experience (no more than 2):

required

Global & Intercultural Learning

Leadership Development

Community Service & Engagement

Professional Development (Workforce Learning)

Holistic Development

Please identify the level of exposure identified for your experience (if more than one wave, experience should address only one consistent exposure level):

required

Discovery- Level 1

Integration- Level 2

Transformation- Level 3

Please give a brief, but detailed description of your experience. This experience should be concise as it will be used on the actual engagement record:

Please provide your reflection question below (Level 1- optional; Level 2 or 3- required). Use the provided guide to ensure your question reflects language used on the level of Bloom's Taxonomy or other words associated with the identified exposure level:

Does this experience expire or have an end date? Please explain and list end date if applicable in terms of TERM and YEAR

Please provide no more than 2-4 learning outcomes you feel are most salient and critical to the experience you are submitting:

Learning Outcome 1:

Learning Outcome 2:

Learning Outcome 3:

Learning Outcome 4:

If you already have attendance for this experience or it happened in the past and you want to get this tagged or you know the students who will participate, then please fill in the template here and submit below (Experiences Attendance Excel Template). Before conferring the expereinces at the end of the semester, we will reach out to have you verify completion and the accuracy of this list:

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