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* 1. Name

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* 2. Title (if applicable)

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* 3. Organization or Business (if applicable)

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* 4. May we contact you for more information? (If yes, please make sure to include your email in the next question)

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* 5. Are you interested in speaking with the press to share your story widely?

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* 6. Email or Phone (whichever is the best way to get in touch)

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* 7. State/Territory/Sovereign Nation

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* 8. Which of the following describes you?

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* 9. Share your story: Please share how recent federal actions like termination of the Local Food for Schools and Child Care Programs, spending freezes, or other program cuts has affected (or will affect) you and your community?

Some ideas for sharing your story:
-What are the specific federal actions affecting you?
-How are they affecting you, your organization, your community, etc.?
-What is one message you would like legislators or the public to know?

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* 10. How would you like your name to appear on any publications?

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* 11. May National Farm to School Network publish your state/territory/sovereign nation?

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