.

10.Does your organization deny to any person on the basis of race, color, national origin, disability, or age, an equal opportunity 

to participate in the organization’s activities and affairs?**YES****NO**

11.Does your organization provide each new member with a copy of the bylaws?**YES****NO**

12.Does your organization provide all members with the bylaws section on the election process?**YES****NO**

a.  Date/time of Annual Meeting:  ____________________________________________________________________________

b.  If no annual meeting, dates/times of nominating or district meetings:  _____________________________________________

c.  Does your organization provide all members advance notice of the annual meeting or election?**YES****NO**

d.  Annual meeting is held at a facility accessible to persons with disabilities?**YES****NO**

13. Indicate number of members appointed to committees listed below *(not including board of directors committees):*

*Complete columns Only for Committees used by your cooperative*.

### RACIAL/ETHNIC

### GROUP

**MEMBER ADVISORY**

**COMMITTEE**

*(1)*

###    MALE     FEMALE

**ANNUAL MEETING**

**PLANNING**

**COMMITTEE**

*(2)*

###   MALE      FEMALE

**ELECTION**

**COMMITTEE**

*(3)*

###  MALE     FEMALE

**OTHER**

**COMMITTEE**

***(Except Nominating)***

*(4)*

###   MALE      FEMALE

**TOTAL NUMBER**

**APPOINTED**

*(5)*

  MALE          FEMALE

****

a.  American Indian or Alaska Native

b.  Asian

c.  Black or African American

d.  Native Hawaiian or Other Pacific

     Islander

e.  White

f.   Hispanic or Latino

g.  Other

TOTAL

  14.Did your organization promote minority and/or female representation on the board of directors during the Calendar Year to more

accurately reflect the composition of your membership:

a.  Appointing minority or female members to fill unexpired terms?**N/A****YES****NO**

b.  Creating at-large positions on the board and initially filling positions with minority or female members?**YES****NO**

c.  Appointing minority or female members to serve as special advisors to the board?**YES****NO**

  15. Did your organization have a quorum for the members’ annual meeting?**YES****NO**

If the response to item 15 is “no,” please answer the following:

a.  Why did you not have a quorum?  *(Please explain in comment section.)*

b.  Was business conducted?**YES****NO**

c.  Were elections held?**YES****NO**

d.  Do you permit voting by proxy or mail ballot?**YES****NO**

 16. Indicate membership and board participation by racial/ethnic category *(Check here if you do not have a nominating committee**and do not complete column 2)*

**RACIAL/ETHNIC**

**GROUP**

**NO. ATTENDING**

**ANNUAL MEETING**

*(Visual Survey)*

*(1)*

###   MALE      FEMALE

**NUMBER ON**

**NOMINATING**

**COMMITTEE**

*(2)*

###   MALE        FEMALE

**NUMBER**

**NOMINATED**

**FOR DIRECTOR**

*(3)*

###  MALE      FEMALE

**NUMBER**

**ELECTED**

**AS DIRECTOR**

*(4)*

###   MALE     FEMALE

**TOTAL NUMBER**

**ON BOARD**

**OF DIRECTORS**

*(5)*

   MALE        FEMALE

a.  American Indian or Alaska Native

b.  Asian

c.  Black or African American

d.  Native Hawaiian or Other Pacific Islander

e.  White

f.   Hispanic or Latino

g.  Other

TOTAL

SIGNATURE OF MANAGER *(see instructions)*SIGNATURE OF BOARD PRESIDENT  *(cooperative ONLY)*

**WILLFULLY FALSE STATEMENTS ON THIS REPORT ARE PUNISHABLE BY LAW (U.S. CODE TITLE 18 SECTION 101)**

RUS Form **268***(Rev. 9-99)*

PART II.   FOR COOPERATIVE-TYPE BORROWERS ONLY

PART III.   SIGNATURES