Walters State Forms
Educational Outreach Event
Event Name:
(required)
Event Date: (mm/dd/yyyy)
(required)
Event Time:
(required)
Short Description of Event:
(required)
Employee Attending Event:
Other employees attending the event:
Number of students attending event:
(required)
Number of others (non-students) attending event:
(required)
Total number attending the event:
(required)
County where event is being held
(required)
Claiborne
Cocke
Grainger
Greene
Hamblen
Hancock
Hawkins
Jefferson
Sevier
Union
Other
Campus associated with event
(required)
Claiborne Campus
Morristown Campus
Newport Center
Niswonger Campus
Sevierville Campus
Other
Primary event contact person
(required)
Primary event contact person phone number
(required)
Primary event contact person email:
(required)
Other important information about the event
Will this event require a followup?
(required)
YES
NO
If yes above, please add a date for followup:
If event requires followup, please explain:
