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:

DOT Agency sponsoring event

Agency Name:

Agency Contact Person:

Phone Number:

Agency Contact Person for this specific event:

Phone Number:

Headquarters/Region/Division/Field:

Partnership School involved: _____Yes ______No (If yes, fill out the following section)

Partnership School

School Name:

School E-mail:

Street Address:

City:

State:

Zip:

Phone Number:

Fax Number:

School Contact Person/Title:

Organization Contact Person (for the School):

Does the school need additional computers?

Does the school have Internet access?

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 return to Charlotte Sakai at 202-366-6361, fax to 202-366-3666, or E-mail to charlotte.sakai@rspa.dot.gov.

Mailing address: U.S. Department of Transportation, Research and Special Programs Administration

Room 8410, Nassif Bldg., 400 Seventh St. SW, Washington, DC 20590