Demographics Collection for Inclusive Programming and Compliance with USDA and Civil Rights Laws (Small Acreage Management)

CSU Extension in Boulder County is committed to providing access to programs and services for all Boulder County residents. Your response will help us ensure that we can continue receiving federal USDA funds to provide inclusive programs to everyone in our community. Please provide the following demographic information about yourself. Your information will remain anonymous and will be reported only in aggregate.

This is a voluntary questionnaire. You are not required to supply this information, but we hope you will. Your information will be kept private to the fullest extent permitted by law. Thank you for your responses!

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* 1. What is your name?

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* 2. City where you live:

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* 3. County where you live:

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* 4. Do you identify as having a disability?

Yes

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* 5. Do you need an accommodation or special assistance that we can provide to access this program? Please specify accommodation request:

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* 6. Do you need sign language or other language translation/interpreter to access this program or service? Please specify language access request:

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* 7. Gender:

Male

Female

Non-binary/Transgender

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* 8. Sexual Orientation:

Lesbian/gay/bisexual

Heterosexual

Asexual

Prefer not to answer

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* 9. Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Other/unidentified

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* 10. What is your race? Please mark all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Unidentified/Other

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* 11. How did our Small Acreage Management Program help you today?

Community class or webinar

Answered Small Acreage Management question by email or phone

Provided plant diagnosis / ID

Site visit

Answered Wildlife Masters Program question by email or phone

Other (please specify):

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* 12. Colorado State University Extension is an equal opportunity provider. | Colorado State University does not discriminate on the basis of disability and is committed to providing reasonable accommodations. | CSU’s Office of Engagement and Extension ensures meaningful access and equal opportunities to participate to individuals whose first language is not English.

Colorado State University Extension es un proveedor que ofrece igualdad de oportunidades. | Colorado State University no discrimina por motivos de discapacidad y se compromete a proporcionar adaptaciones razonables. | Office of Engagement and Extension de CSU garantiza acceso significativo e igualdad de oportunidades para participar a las personas quienes su primer idioma no es el inglés.

For the full USDA Non-Discrimination Statement, Language Access and Reasonable Accommodation in both English and Spanish, please visit https://col.st/ll0t3