| YOUR AAA
LOGO |
Your COG/United Way Program AAA of ________________ Your Name______________ Address of AAA__________ Business Phone___________ Fax Phone_______________ Your E-mail______________ |
LEGAL AWARENESS ACTIVITY REPORT
Location: __________________________________________
Contact Person: __________________________________________
Date & Time: __________________________________________
Topic: __________________________________________
Target Audience: __________________________________________
Number of Attendees (include sign-in sheet) See attachment
Briefly describe the type of presentation and include the form of media used, such as speech, audio/visual materials or other resources used.
__________________________________________________________________________________________
I certify that the above information is correct and that the above referenced activity(ies) meets the definition of the provision of Legal Awareness (the dissemination of accurate, timely and relevant information, eligibility criteria, requirements and procedures, to older Texans about public entitlement, health/long term care, individual rights, planning/protection options, and housing and consumer issues). If applicable, please attach a copy of the information disseminated.
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_____________________________________ Staff Presenter/Volunteer |
For Office Use Only AAA Staff Initials:_____________ Date: __________Units: _______ |
Benefits Counseling Certification Program Chapter Two--6/2000