Equal Opportunity - Cooperative Extension in Penobscot County - University of Maine Cooperative Extension

Equal Opportunity For All

Thank you for choosing the University of Maine Cooperative Extension for your educational needs. It is important that we ensure equal opportunity to all who might benefit from our programs. As a way to document those we are reaching, we are seeking the following information on an optional and anonymous basis.

Event Name*

If you cannot remember the exact name of the program, no worries. A description of the event or program is also sufficient.

Date of Event

Role

Youth Participant (4-H member)
Youth Participant (non-4-H member)
Adult Participant
Volunteer

Gender

Female
Male
prefer not to answer
Gender not listed

Gender - Gender not listed: Please specify

Race/Ethnicity

Please check all that apply

American Indian/Alaska Native
Asian
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Native Hawaiian and other Pacific Islander
White (Caucasian)
Other

Race/Ethnicity - Other: Please specify

Where do you live?

Farm
Rural
Town (10K-50K)
Suburb
City (50K+)

Grade Level