Museum Visit Report Form

Name ______________________________ E-mail Address _____________________

Name of Museum Visited ________________________________________________

Date of Visit __________________ Time In ___________ Time Out ___________

Description of Exhibits (Temporary and Permanent) and Summary Information Related To Arkansas History. (USE ADDITIONAL PAGES TO COMPLETE THIS SECTION.)

"I hereby verify that this student visited our museum on the date and at the times specified. The student seemed to make this visit a worth while academic exercise."

Museum Contact Person __________________________________ (Signature)

Title _______________________________________ Work Phone ____________________

Date Signed _______________________ Time ____________

*Notes: Obtain the required signature and mail or FAX (501-279-4626) the form to: Dr. Tom Howard, Box 12247 HU, Searcy, AR 72149

Student Understanding and Commitment Form

"I have read the Policy on Plagiarism.  I understand what the policy says and I commit to being completely honest with regard to its contents.  I realize that failure to do so will result in an "F" for the course." 

_________________________________                ______________
Signature                                                    Date
 

Print Name _____________________
 

(Sign, detach and mail to:  Dr. Tom Howard, Box 12247 HU, Searcy, AR 72149)