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Gender: ❑ Male [jemale Age . <br /> ❑Less than 18 ❑45-64 <br /> Disability : ElYes❑No ❑18-29 ❑65 and older <br /> ❑30-44 <br /> choose not to provide any of the information requested above : ❑ <br /> Completed forms will remain on file as part of the public record . For more information regarding Title VI <br /> or this request, please contact the OCTS at 919 - 245 - 2008 or by email at <br /> octransportationservices@orangecountync . gov . <br /> Please sign below acknowledging that you have completed this form . Thank you for your participation ! <br /> Name ( print ) : <br /> Signature : <br /> ® Key Community Contacts <br /> Contact Name Community Name Interest or Affiliation Also a <br /> Committee ' <br /> Member? <br /> (Y/N ) <br /> Shannan Barnes Orange County Family Success Alliance N <br /> Marlyn Valeiko Orange County LEP Specialist/Outreach N <br /> Contact information for key community contacts is not public information and is maintained outside of <br /> this document . Any staff member who wishes to contact any individual listed above must request that <br /> information from the Title VI Coordinator . <br /> ® Summary of Outreach Efforts <br /> The following format is used to document URTS outreach efforts in reports to NCDOT . All meetings and <br /> disseminations of information capture information for the table below : <br /> Meeting Date Meeting Time Meeting purpose Target Audience Information Disseminated <br /> 9/19/2020 11am Transit Services in General Public Brochures, Bus Rider 101, Bike on <br /> Orange County Bus <br /> Information <br /> 9/20/2020 11am Transit Services in General Public Brochures, Bus Rider 101, Bike on <br /> Orange County Bus <br /> Information <br />