Garrett A. Morgan Technology and Transportation

Futures Program Activity Report 2000

Please submit one form for all Morgan Program events.

 

Event

Event Name:

Event Time:

Event Date:

Date Submitted:

Event Location (include the address):

Street Address:

City, State Zip:

Event Speaker/Facilitator(s)

Name(s):

Phone Number:

Title(s):

Fax Number:

Function (facilitator, speaker , etc.):

E-mail Address:

Roundtable Organization Sponsoring the Event

Organization Name:

Organization Contact Person:

Title:

Phone Number:

Fax Number:

Address:

City, State, Zip:

Event/Activity Description

 

 

 

 

 

 

 

Students attending the event

Number of Young Students ______ Number of Adult Students ______ Total Number of Students ______

Audience Level:____ K-5 ____ Community College/Tech School ____ Life Long Learning
____6-8 ____ Undergraduate ____ Other

____ 9-12 ____ Graduate

Please contact Charlotte Sakai at 202-366-6361 with any questions regarding this form.

Please return completed forms to:

Charlotte Sakai

U.S. Department of Transportation

Research and Special Programs Administration

400 Seventh Street, SW, Room 8410

Washington, DC 20590

Fax: 202-366-3666

E-mail: charlotte.sakai@rspa.dot.gov