Individual Experience Form
This experience form is for:
An individual
A group of individuals
Staff experience or event
Individual name:
First Name
Last Name
List all individuals included in this group:
Staff name:
First Name
Last Name
Division:
Park West Court Apartments
Johnstown
Supported Community Living
Career, Activity, & Community
Open Door Stage and Screen
Open Door Art Studio & Gallery
CCHS @ UCO
Corporate
Staff Division:
Park West Court Apartments
Johnstown
Supported Community Living
Career, Activity, & Community
Open Door Stage and Screen
Open Door Art Studio & Gallery
CCHS @ UCO
Corporate
Experience type:
Community Experience
In-House Experience
Cultivate Circle
Staff Experience type:
Community Experience
Team Building
Special Event
Training
Volunteering
Cultivate Circle
What update would you like to share?
Community Experience
In-House Experience
Artwork
Resume
Artist Bio
Cultivate Circle
Artwork for:
Exhibition
Online Store
Portfolio
Exhibition name:
Title:
Size:
Medium:
Price:
Resume (type here or upload below):
Artist Bio (type here or upload below):
Method of transportation used:
Public
Private
Not Applicable
Location of experience, Cultivate Circle, or exhibition:
Duration of activity:
Please describe the activities that took place and the outcome of the experience:
Please describe the activities that took place:
Please describe the individual's next steps as identified in the Cultivate Circle:
Please upload photo(s) from the Experience or Cultivate Circle:
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Please upload photo(s) from the staff experience:
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of
Please upload resume/bio:
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Please upload photo(s) of the artwork:
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For supervisor use:
Was the experience tied to individual's goal(s)/outcome(s)?
Yes
No
What goal(s)/outcomes were they tied to?
Please upload any additional photos received that are not already included
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of
Submit
Should be Empty: