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Student Engagement Transcript Form 

ATTENTION: Please note, if any information documented on this form is found to be incorrect, incomplete, or is not verified by an Advisor and/or Supervisor, this entry may not be included on your Student Engagement Transcript.   

NOTE: All information must be entered before a Transcript request can be processed. 

Have you started documenting activities for your leadership transcript prior to today?  

Personal Information:

First Name: 

Last Name: 

G Number:    
Please include the "G" when entering in the field above.



Entry Information:

Submit an entry for each event or activity you participate in and a separate entry to enter an honor, award, or club/organization affiliation. (ie. a separate entry would be made to report an office held in an organization)

Complete Event Title/Activity Name (skip this if reporting club/organization officer/member status): 

Sponsoring Organization/Club for an event or name of Club/Organization for which you are reporting your officer/member status (if applicable)

Sponsoring Department (if applicable)  


Semester you participated:  Year you participated: 

What was your role? (Please choose the role that best describes your highest level of involvement)

 If you selected "Other" please enter your membership/participation role: 

How many hours did you dedicate to the event/activity?  (if this entry is to simply identify membership in an organization you can either estimate number of active hours or enter "0", the "0" will not appear on the transcript but the membership will.)



What is the title of the person who oversaw participation in this activity/event? 

If you selected "Other", please enter the advisor/supervisor's title here: 

Advisor/Supervisor Name: 

Advisor/Supervisor Email:  

Click here for a list of commonly referenced supervisors.



What did you learn from this program?   

How will you implement these skills into your life?   

Learning and Development Outcome Category (As identified at the program): 

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