University Community Outreach Assessment Form
Please complete this form to help us evaluate and improve our university's community outreach initiatives.
Name
First Name
Last Name
Email Address
example@example.com
Affiliation with University
*
Please Select
Student
Faculty/Staff
Community Member
Partner Organization
Other
Which community outreach activity are you assessing?
*
Please Select
Educational Workshop
Health Fair
Environmental Project
Cultural Event
Other
Date of Outreach Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the following aspects of the outreach activity.
*
Rows
Excellent
Good
Fair
Poor
Organization
1
2
3
4
Communication
5
6
7
8
Relevance to Community Needs
9
10
11
12
Accessibility
13
14
15
16
Engagement
17
18
19
20
How effective do you feel this outreach activity was in achieving its goals?
*
Not effective
1
2
3
4
Highly effective
5
1 is Not effective, 5 is Highly effective
What benefits did you or your community gain from this outreach activity? (Select all that apply)
*
Increased Knowledge/Awareness
Access to Resources/Support
Networking Opportunities
Skill Development
Other
Please rate your overall satisfaction with the outreach activity.
*
1
2
3
4
5
What challenges or barriers did you experience during the outreach activity?
Do you have any suggestions for improving future outreach activities?
Submit Assessment
Should be Empty: