OCMGA Contacts/Activities Report

 

Outreach / Educational / Other: _____________(Please indicate)

 

Date(s):            _____________

                          (month, day & year)

 

Name/Type:   _______________________________________________

                          (Fair Booth, Arbor Day, School, Garden Club, Country Store, Civic Group; Plant Sale

                             Adult Classes, Neighborhood Assoc., Library, Filming etc…)

 

Purpose:         _______________________________________________

                        (Community Awareness, Education: Adult/Children/General Public, etc)

 

 

Community Contact(s):    Name: ____________________   Ph:  _____________

                                             Email:  _____________________________________

Procedures Taken:  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Educational Materials:  ________________________________________________________________________________________________________________________________________________________________________________________________________________________

MG Participants:  ________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendation(s):    ________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Repeat this?  YES/NO          Photos?  YES/NO          INFO requests handled?  YES/NO

                                                                                            

Additional UF   REQUIRED    Information:  (circle one)

                                                    Nat. Amer. / Hisp / Cauc / Asian / Af. Am. / Unknown

                               Number of:    _____      _____     _____   _____    _____        _____

 

Number of Contacts:  Male ______     Female ______    Total Contacts: _________                                                  

 

MG reporting:  ________________________________                                       

                                            (Please Print)

 

If additional space is needed please use the reverse.                                                                                                                                                              

 

 

 

 

Revised 12/10/07: / esf