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SENCER FastLane: Outreach Activities Report

Please use the form below to provide information on presentations or publications about your SENCER work.  If you have more than one outreach activity to report, please complete the form for each of the activities.
Please Note: This page is best viewed and completed in Internet Explorer 5.5 or higher. Fields marked with an asterisk are required. Please do not enter any special characters and bullets (ex: ,"/?:) in the large textboxes below as it will automatically be deleted when the form is processed. Thank you.
A. Basic Information
First Name:*
Last Name:*
Academic Title:*
Institution:*
E-mail:*
Phone Number:*
Additional Individuals: Please include institutional/organization affiliations only if different from that of the primary individual. (400 characters max.)
B. Outreach Activity Information
1. Type of Activity:* Session
Workshop
Plenary/Keynote
Symposium/Multi-Day Event
Poster
Consultation
Publication
2. Title of Activity (Presentation/Publication):*
3. Date of Activity or Publication Date:*
C. Additional Information About Activity  

4a. Presentations Only: Type of Coordinating Organization/Institution

4b. Presentations Only: Coordinating Organization/Institution Name
4c. Presentations Only: Title of Event

4d. Publication Citation Information:
Please provide complete citation information for the document you published.
5. Presentation Abstract (Max. 150 words):*
(Note: Please be sure to include some phrases that describe what the participants will learn/gain by participating in your session.)
III. Follow-up

1. Please comment on any evaluation information that was collected.  If you have a report on the evaluations or the actual evaluations you would like to send to us, please email these to sencer@sencer.net. 

2. If you are planning on conducting any additional outreach activities, please provide the approximate date, location, event, and title of your activity.  If you plan to publish further, please describe the topic briefly and note any collaborators.