East Region ANR Outcome Programs

These scan forms were developed by the East Region RPD-ANR and Organizational Development to provide some common indicators of ANR programmatic impact for counties in the East Region. The forms can be customized in two ways.

First, common indicators are available via pull-down menus for change in understanding and intentions to adopt. You have the flexibility to select any number of these indicators and/or add your own items in these fields. Second, on forms that have participant background and economic impact questions, these questions can be removed via a toggle box if they are not appropriate for your particular event (i.e., if the program is a series of events and you only need to capture participant background and economic impact at the last event in the series).

Your modifications to these forms cannot be saved; only printed so that you can make copies for your program event. Direct any questions about the content of the forms to your RPD-ANR.

NOTE: the form will open a new tab or window in your browser. Also, if a form has 2 pages, be sure to print both sides of the form even if you don’t use questions on page 2 (both sides should have 4 cornerstones).

Interpretation Guide

Saving a Customized Scan Form

Good news! You can now save a copy of the scan form PDF after including your customizations (i.e., items inserted using pull-down menus, typed-in items, questions hidden with use of toggles). Go here to learn how.


Do not combine forms (i.e., using the front side of one form with the back side of another form). This type of form is not scannable which means your survey set will be sent back to you unprocessed. Thanks.

Scan Forms

(county pull-downs) denotes forms with pull-down lists to fill-in counties most likely to be selected on page 2 of the form, plus “other” or “other, specify” as the last response category. You can also use the toggles to remove unneeded response categories. By listing counties, you’ll receive additional results for intentions to adopt and anticipated economic benefit by county)

4-H Livestock Project

  • Livestock Project  (Pre) (Post)

Cropping Systems

  • Crops (use for one or more crops)
    Page 1: pull-downs for crop heading(s) and toggles to hide unused columns
    Page 2: pull-downs for indicators of knowledge gain/adoption or type your own items

Livestock Production

Natural Resources Management

Small Acreage Management

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