Evaluation Survey for Farm *A* Syst

c10-Question Survey for Farm *A* Syst

Thank you for participating in the Farm Assessment System (Farm *A* Syst) program. This program is designed to help you identify and reduce the risk of environmental problems of your property, including the risk of pollution to your water supply. It is also very important for our office to be aware of the effect the program has, and how we can improve it. In order to do this, we ask that you print and fill out this short l0-question survey after you have undergone the program and decided whether or not you will make (or have made) any changes recommended in the materials.

1. Which State and county do you live in? (state)_______(county)________

2. How was the program delivered to you?(please circle one letter)

a. Attended a group workshop sponsered by (please specify)__________
b. One-on-one assistance from an Extension, NRCS (SCS), or other government person
c. One-on-one assistance from a volunteer service person (such as an AmeriCorp, 4-h, Master Gardener, or other volunteer service organization)
d. Assisted by a private consultant
e. Completed vthe program with no assistance
f. Other method of delivery (please specify)____________

3. Did you complete an assessment of your property?(please circle one letter)

a. Yes, I answered most of the questions that apply to me and calculated my risks (by writing in numbers from 1-4) for each area.
b. Yes, I read through some of the materials but did not fill in any numbers relating to risk.
c. No, I did not read or complete any of the worksheet questions or read any of the factsheet materials.

4. What is the source of your drinking water? (please circle one letter)

a. Private water well
b. Community or municipal water supply

c. Bottled water
d. Other(please specify)_______

5. In which group of worksheet questions did you identify a "high risk" as it relates to your property? (please circle all those that apply)

a. Water well condition and/or location
b. Pestcide storage and handling
c. Fertilizer storage and handling
d. Petroleum product Storage
e. Farmstead hazardous waste management
f. Household waste water (sewage) treatment

g. Livestock waste management
h. Poultry litter/carcass management
i. Other (please specify)__________

6. Do you have any children (under age 18) living in the household?(please circle one)

Yes
No

7. About how many acres was your farm (or rural property) last year? (please circle one letter)

a. less than one acre
b. 1-9 acres
c. 10-49 acres

d. 50-179 acres
e. 180-499 acres
f. 500-999 acres

g. 1,000-1,999 acres
h. 2,000 acres or more

8. Please indicatee below any recent changes you have made (or plan to make) in your management practices or to your property to reduce the risk of environmental problems that are mainly a result of information you learned from undergoing the Farm *A* Syst program. This question is very important to us, so please answer it as thoroughly as possible.

Brief Description of Change	Out-of-pocket cost to you	Time spent on change(hrs)	Date of change	Change is planned
#1) .	.	.	.	.
#2) .	.	.	.	.
#3) .	.	.	.	.
#4) .	.	.	.	.
#5) .	.	.	.	.

9. Do you think the Farm *A* Syst program was worth doing and would you recommend it to your neighbors?(please circle one)

Yes
No
Undecided

10. How could we make the Farm *A* Syst program better or more useful for you or your neighbors?(please write in the space provided)

Thank you for your time and effort in comleting this evaluation. Please mail the completed survey to:

Deanna Osmond
NCSU
BOX 7619 Raleigh, NC 27695-7619