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COOPERATIVE AGREEMENT NO. C-1-3252 <br />EXHIBIT A <br />ATTACHMENT <br />jot <br />Senior Mobility Program OCGO <br />FA <br />ceca/ra+adbrs ar worX OCTA <br />Monthly Reporting Form <br />Agency Information <br />Service for the - <br />Participating Agency: <br />Agency Contact Name: <br />Contact Number / Email: <br />Month of: July Year of: 2021 <br />i Operational Data - <br />Trip Category <br />One -Way Trips <br />Service Hours <br />Service Miles <br />Jul 2021 <br />FYTD <br />Jul 2021 <br />FYTD <br />Jul 2021 <br />FYTD <br />Senior Center <br />Medical <br />Nutrition <br />Shopping <br />Personal Care <br />Social & Recreational <br />Amusement Park <br />- <br />- <br />Aquarium / Zoo <br />Beach / Park <br />- <br />- <br />Charity -Social Group Event <br />- <br />community -Cultural Event <br />- <br />- <br />Education / Employment <br />- <br />- <br />Family -Friends <br />- <br />Funeral / Memorial Service <br />- <br />Government Office / Service <br />- <br />Library / Museum / Historical Site <br />- <br />- <br />Movies / Theater / Concert <br />Religious Institution <br />- <br />Restaurant <br />- <br />Sporting / Fitness. <br />- <br />Transit Center / Hub <br />- <br />Total <br />Declaration and Submission Confirmation <br />Agency hereby certifies that this report is a complete and correct statement of the programs operating data. <br />Submitted By: <br />Signature: <br />Date: <br />THIS REPORT IS DUE NO LATER THAN 30 DAYS AFTER THE END OF THE SERVICE MONTH <br />Please send this report by email to CTSPROGRAMS@OCTA.NET. <br />