Voluntary Demographic Information Form

Each person involved in Extension programming should report the demographics of the audiences they served.  This applies to all, whether programming occurs at the state or local level.  This information is required by USDA.  

In order to assist in collecting the required demographic information, Voluntary Demographic Information cards have been developed.  It is not a requirement that either of the forms below is used, however it is necessary that we capture audience demographics accurately.  Thus, one may use either form below or another tool if it is more convenient. 

When using Voluntary Demographic Forms, be sure that they are given to all who are in attendance at a program.  It is not appropriate to “guess” the demographic information for part of a group and give the form to others for completion.   It is important to note that participants are not asked for their names or other personal, identifying information.  Thus, the forms should be collected in an envelope, basket or drop box so that individuals do not feel as though they are being singled out or identified personally with their information card.  Later, the employee may use this card as a reference in reporting audience demographics on the statewide reporting system.  This information will be used to evaluate our programs for equity, as part of our statewide Affirmative Action Plans.

To facilitate use with all audiences, the cards are provided in both English and Spanish in an easy to read format.  These Voluntary Demographic cards are not to be “turned in” to the state office.  They are simply a tool to assist in collecting pertinent information.

If you have any question about the use of either of the cards below, please do not hesitate to contact Julie Middleton at 573-882-3407 or by email at middletonj@missouri.edu.

Voluntary Demographic Information Form 1 (Original version)

Voluntary Demographic Information Form 2