National Farm to School Network's (NFSN) information collection process for the Racial Equity Learning Lab

OMB Number: 0584-0611

Expiration Date: 11/30/2025

OMB BURDEN STATEMENT: This information is being collected to determine what additional resources and information are needed to advance racial equity in farm to school work. This is a voluntary collection and FNS will use the information to carry out EO 14058 “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” to ensure government is carrying out more equitable and effective services. This collection does not request any personally identifiable information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0611. The time required to complete this information collection is estimated to average less than one hour per response, including the time for reviewing instructions and answering the survey questions. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-0611). Do not return the completed form to this address.

Appendix A: Intake Survey-Zoom Registration

Demographic Questions:

1. Name:

2. Email Contact:

3. Location (City/State, Sovereign Nation, or Territory): 

4. What is your ethnicity? Please select one.

Options: Not Hispanics/Latino/a/x/e; Hispanics/Latino/a/x/e; Decline to state; Write in (insert text box)

5. What is your race? Please select all that applies.

Options: Asian/Asian American; Black/African American; Indigenous American/Native Alaskan; Middle Eastern/Arab American; More than one race; Pacific Islanders/Native Hawaiian; White; Decline to state; Write in (insert text box).

6. Scale – Racial equity work is a continuous journey. Using the National Equity Project’s Leadership Stance, which leadership stance feels relevant to where you are in your journey related to racial equity?  

• See - How you perceive the world (window) and practice self-awareness (mirror). 

• Engage - How you “show up” and engage relationally - how you listen, build relationships, and create conditions that foster greater alignment in this complex work. 

• Act - How you design, decide, implement, learn; how you influence direction, bring focus to your actions, and engage in safe-to-fail experiments. 

7. Do you feel equipped to advance racial equity in your farm to school work? (Yes, No, Not Sure)

8. Mark all that apply - I will feel equipped to advance racial equity in the farm to school movement if:

• I participate in training/webinars centered around racial equity.

• I get connected frequently with people doing the work of embedding racial equity in their practices.

• I had resources available to me.

• I had time.

• I had the support from my manager / organizational leader.

• Other(s): ______________________

9. Text - What do you intend to gain from attending the Racial Equity Learning Lab Webinar?

10. Text- What do you think is needed in your state or local community to embed racial equity in your farm to school efforts?