Summary: Questions? Contact Program Coordinator, Iris Crowe-Lerma
858-822-7618 · firstname.lastname@example.org · Visit the Well-Being Tab on TritonLink
Health, Recreation & Well-being Leadership Award Program
TO RECEIVE CREDIT FOR ATTENDING A WORKSHOP AND/OR CLASS, PLEASE SUBMIT THIS FORM TO HEALTH, RECREATION & WELL-BEING IN STUDENT
SERVICES CENTER, SUITE 562 OR EMAIL TO IRIS CROWE-LERMA AT ICROWELERMA@UCSD.EDU
PID: Name: Email:
Date Attended: Location:
Dimension of Wellness you would like this workshop/class to fulfill (circle one option below):
Emotional · Environmental · Financial · Intellectual · Leadership · Occupational · Physical · Social · Spiritual
Please check the appropriate answers to the questions included below. All information included on this form will remain
confidential (your name will be removed).
Disagree Disagree Neutral Agree Agree
1. I am satisfied with the quality of the presenter/presentation.
2. I learned a new wellness or leadership skill as a result of this
3. I learned more about a UCSD health, recreation or