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Gender: ❑ Male aemale Age. <br /> ❑Less than 18 ❑45-64 <br /> ❑18-29 ❑65 and older <br /> Disability: ❑ Yesao <br /> ❑30-44 <br /> 1 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 /> G. 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 />