JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Activity Log for 2024-2025
This activity log is intended to document your hard work!
If you have multiple activities to log, there will be a link at the end of the survey to submit another activity.
Refer to the
SD-IPPE syllabus
for more information.
If you have any questions about your hours or previous logs, please reach out to Ms. Jacien (
julia.jacien@wilkes.edu
).
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name (no nicknames)
*
Your answer
Last Name
*
Your answer
What is your anticipated year of graduation?
*
Choose
2025
2026
2027
2028
Who is your advisor?
*
Choose
Dr. Bolesta
Dr. DeLuca
Dr. Jon Ference
Dr. Kim Ference
Dr. Franko
Dr. Gruver
Ms. Holt-Macey
Dr. Kieck
Dr. Lewis
Dr. Mahato
Dr. Malinowski
Dr. Manning
Dr. Nguyen
Dr. Pezzino
Dr. Rahman
Dr. Roke-Thomas
Dr. Trombetta
Dr. VanWert
Dr. Warunek
Dr. Wellings
Dr. Sklanka
Which of the following activities would you like to submit?
*
Patient Care Hours
Community Service Hours
Leadership Position
Research
Presentations
Conference Attendance
Other Activity
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wilkes University.
Report Abuse
Forms