Experiential Program Form

Group Name

This is your organization's or department's name.
Contact Name

This is your main point of contact for coordinating with Outdoor Adventure.
Contact Phone Number Contact Phone Number - ### - ### ####
Contact Email
CWID/Banner ID (if applicable)
Affiliation to OSU

Affiliation to OSU Student Faculty Staff Alumni Other Other
Desired Date Desired Date / MM / DD YYYY
Alternative Date Alternative Date / MM / DD YYYY
Number of Participants
Program Type

Program Type Group Development (on campus) Climbing Gym Customized Off Campus Trip
Length of Program

Length of Program 2 Hours Half Day (4 hours) Full Day (8 hours including lunch) Over Night Trip
Desired Start Time Desired Start Time : HH MM AM/PM
Desired End Time Desired End Time : HH MM AM/PM
Desired Group Outcomes