Student Co-Curricular Transcript Activity Submission Form
Please fill in the following information regarding your involvement in a co-curricular activity at the University of Arkansas - Pulaski Technical College. This form must be submitted before the end of the semester in which the activity was completed.
Once you have completed the form, it will be sent to the advisor/faculty/staff you have designated to approve your activity participation or project completion. After your designee has approved the activity or project you will be notified that this submission will be added to your official UAPTC Co-Curricular Transcript.
If you have questions or concerns, please contact Michelle Anderson at
Name (First & Last)
UAPTC Student ID Number
Provide the name of the activity and describe the tasks, assignments, or projects you have completed. Please provide no more than five (5) examples or how you were involved in the activity.
Name of Co-Curricular Activity
Describe You Involvement in Activity
Select the skills you learned or enhanced as a result of your involvement in this activity
Accountability (CCLO #1, #3, #)
Communication (CCLO #1. #2, #3)
Cultural Awareness (CCLO #2, #5, #4)
Diplomacy (CCLO #1, #2, #3, #5)
Event Planning (CCLO #1, #3)
Financial Management (CCLO #3, #4, #5)
Leadership (CCLO #1)
Marketing / Publicity (CCLO #3, #5)
Mediation / Negotiation (CCLO #1, #2)
Motivation (CCLO #4)
Organization / Scheduling (CCLO #4)
Social Justice (CCLO #1, #2, #3)
Stress Management (CCLO #4)
Time Management (CCLO #4)
Team Work (CCLO #1, #2, #3)
Social Media (CCLO #3)
Would you like to share any additional thoughts about the event?
Designated Witness (Activity Verification)
In the section below please provide the name and contact information for the person and/or organization that can verify your participation in the activity.
Name of Witness
Email of Witness
Sponsoring Organization (Optional)
Send me a copy of my responses.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service