Please help us track and improve our outreach by filling out the information below after each STEM AVSED event. 

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* 1. First Name

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* 2. Last Name

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* 3. Your FAA Region

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* 4. Your Line of Business/Staff Office

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* 5. Your FAA Email Address

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* 6. Your Work Telephone Number
Please do not include your personal phone number

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* 7. Did more than one FAA employee support this outreach event?

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* 8. Outreach Event Name & Location

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* 9. Date of Outreach Event
(if multi-day event, enter date of final day)

Date

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* 10. Primary Outreach Event Audience

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* 11. Outreach Event Type

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* 12. Partnering Organization, if any

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* 13. Outreach Event Category

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* 14. Estimated number of... 
(if outreach event lasted multiple days, estimate for the entire event)

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* 15. Did the Outreach Event focus on any of the following populations?

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* 16. Estimated Percentage of Attendees Who Were...

  0% 25% 50% 75% 100%
Women
Minorities
People of color
Economically disadvantaged
People with disabilities

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* 17. Optional: Brief Description of Outreach Event

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* 18. Optional: Additional Comments or Feedback

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