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CROP SIGN UP FORM
If you answered "other" above and prefer to say, please write pronoun below:
Full Mailing Address
Best Phone Number
Staff or scheduler name and email
Black or African American
Caucasian or White
Prefer not to say
If you answered "other" above and prefer to say, please indicate your race below:
In which chamber do you serve?
House (or equivalent?)
When were you first elected to the legislature?
Is your district rural or have a rural component?
Are you in a leadership position and if so, what is that position? If no, please type NA
Please indicate whether you are in the majority or minority in your state. If you are an independent, click "other."
Do you currently sit on a committee that hears issues related to agriculture?
If you answered "Yes" to the above question, which committee(s) do you serve on? If the answer is "no" please type in NA
If you serve on a committee that hears issues related to agriculture, are you a ranking member? If so, please tell us your title. If no, please type NA.
Please check all issue areas that you are interested in:
Agriculture as a climate solution
Local food and farms
Creating local food economies (value added processing)
GMOs / Genetic engineering
Farmer equity & diversity
Concentrated animal feeding operations
Right to repair farm equipment
Right to farm laws
Farmed animal welfare
Farm worker justice
slaughter & processing
Mitigating agricultural pollution and runoff
Farmer access to capital
Please use this space to expand on any of the above issues or list an issue(s) that wasn't previously listed. If you have nothing to add, type NA.
Which organizations in your state do you look to for information and/or guidance on farm policy?
Do you feel like you hear the progressive point of view on agricultural policy?
Yes, I do or I know where to find the information.
No, I have no idea where to go to find this information.
If Other, please let us know
How can SiX help you be a champion for progressive agricultural policy in your state? Please check all that apply
Connect with farmers in my state that aren't represented by traditional farm groups.
Connect with local progressive organizations working on food, farm or rural issues.
Timely issue briefings
Recording library of webinars and podcasts about issues that can be accessed on demand.
Connect with other legislators in other states that are facing similar issues
Help support regional collaboration on agricultural issues
Support line to answer questions as they come up
Legislation toolbox organized by issue
Navigating ag/rural committee assignments
National bill tracking in an issue area
News article collection on particular issue areas
Connecting with journalists
Social media amplification on agriculture issues
Are you interested in joining an issue-focused legislator working group? If yes, please pick from the options below.
Justice for Black farmers and farmer equity
Soil health and regenerative agriculture
Cannabis Equity and Hemp
Food and Farm Workers
Local Food Infrastructure and Meat Processing
If Other, please let us know
Please use this space to expand on any of the above resources or list an issue(s) that wasn't previously listed. If you have nothing to add, type NA.
In this policy space, what should we know about you? Do you come from a rural background? Are you new to the space? Have you done something interesting in your state that other SiX legislators should know about? Please tell anything pertinent.
How did you hear about the CROP?
Colleague in the State Legislature
Invited by a State Innovation Exchange Staff Member (if so please put their name in the answer space in the next section)
State Innovation Exchange Event (Webinar or Conference)
If you answered 'other' to the above question or were invited by a SiX staff member, please put your response below.
What is your Twitter handle?
What is your Instagram handle?
What is your Facebook handle?
Other social media handles?