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Email Address*

Full Name*

Pronouns*

She/Her/Hers
He/Him/His
They/Their/Theirs
Other

If you answered "other" above and prefer to say, please write pronoun below:

State*

Full Mailing Address*

Best Phone Number*

Staff or scheduler name and email

Race

If you answered "other" above and prefer to say, please indicate your race below:

In which chamber do you serve?*

House (or equivalent?)
Senate
Other

When were you first elected to the legislature?

Is your district rural or have a rural component?*

Yes
No

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."*

Majority
Minority
Other

Do you currently sit on a committee that hears issues related to agriculture?*

Yes
No

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:

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.
Other

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

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
Corporate Agribusiness Accountability
Building Progressive Power Through Rural Organizing

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?*

If you answered 'other' to the above question or were invited by a SiX staff member, please put your response below.

What is your X (formerly know as Twitter) handle?

What is your Instagram handle?

What is your Facebook handle?

Other social media handles?

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SiX's Cohort for Rural Opportunity and Prosperity (CROP)

If you are interested in joining SiX's Cohort for Rural Opportunity and Prosperity (CROP), please fill out the survey below.

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