First name

Last name

Page 1 of 1

In order to receive points for your participation, please fill out the information below. All of the information MUST be filled out.

1. Name [First and Last].

2. ASU email address.

3. Expected Graduation Date [Month/Year.]

4. Select Yes or No. "I participated in the educational session to hear about Mary Grey and her service dog Shiitake. Yes No

5. Please type your initials below. This serves as your signature confirming that you did in fact attend the Educational Session on Friday, October 2, 2009.

Please copy the word in the above image.