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-A Division of Crest FFA-

AG MEDIA SURVEY

To Participate in our Survey, please complete all the following fields. This form is for Kansas Region Number One According to the previous map.

Age Group (for research only)
Are/Were you in FFA
Are/Were you in 4-H or other AG program not listed
How often are you directly involved in Agricultre
What is the population of the area you reside in
Is your child or anyone of close relation to you involved in FFA/4-H
Do you or your family reside on a farm?

By Agreeing to the Terms and Conditions and submitting this form you are consenting to have the results of this survey released and put into our student's projects. You are consenting any and all information providied to be shared with our students and reflected and used in our work.

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