Farmers of Color Network Intake: Farmer Member Farmers of Color Network Intake: Farmer Member Thank you for your interest in the Farmers of Color Network! This form is for farmers of color who wish to join the network and are actively farming in our geographic region (AL, AR, DC, FL, GA, KY, LA, MD, MS, NC, SC, TN, VA, U.S. Virgin Islands, and Puerto Rico). Please fill out the following information about yourself and your farm. This intake helps us understand who you are, what you grow, and what services or support we can offer. Please be in touch with any questions: Ray Jeffers, Farm and Outreach Specialist, [email protected] Farmer Contact Information First Name Last Name Mobile Phone Number Home/Alternate Phone Number Email Address Mailing Address City StatePlease select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY N/A PR VI DC Postal Code County Farmer Information Cont'd Race Black/African AmericanLatinxNative AmericanAsian Multiracial/BiracialWhiteOther (Please describe) Other: GenderFemaleMaleNon-BinaryOther Other: Birthdate What year did you begin farming? Are you a veteran?YesNo Farm Information Farm Name If you do not have a farm name, please enter [Your Name] Farm. Is your farm address the same as your mailing address?YesNo Farm Address Line 1 City StatePlease select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY VI PR DC Postal Code County Do you file a Schedule F tax form for your farm?YesNo Does your farm have a Farm ID?YesNo Year current farm operation began: Total Acres in Production: Acres Leased: Acres Owned: Farm Products/Enterprises: Check all that apply AgritourismAquaponics/HydroponicsBeesCattleEggsFiberFish / SeafoodFlowersForestryFruitGoatsHempHerbsHogs - ContractHogs - IndependentHorticultureNutsOrchardPoultry - ContractPoultry - IndependentSheepValue AddedVegetableVermicultureOther Other products/enterprises: How do you market your products? Check all that apply Retail/Direct SalesWholesaleProduction/Marketing Contract CSAFood Hub or CooperativeU-PickOther - describe Other markets: Please select any current farm certifications below.GAP CertifiedCertified Organic Certified Naturally GrownCertified HumaneAnimal Welfare ApprovedFood Justice CertifiedB-CorpOther Year of certification (if applicable) What percentage of your income do you earn from farming?0 - 25 %26 - 50%51 - 75 %76 - 99% 100% How many non-family employees does your farm have? How many family employees does your farm have? Were you previously certified and/or do you follow organic practices? Do you have a clear title to the land?YesNo What is the land ownership status? Are there any heirs or property issues? Do you have estate planning assistance needs? Which of the following FSA programs have you received funding or assistance from? Select all that apply.Direct Loans from the FSALoans Guaranteed by FSACCC Farm Storage Facility LoansMicroloans from the FSAELAP: The Emergency Assistance for Livestock, Honeybees, and Farm-Raised Fish ProgramLIP: Livestock Indemnity ProgramNAP: Noninsured Crop Disaster Assistance Program ECP: Emergency Conservation Program None of these programsOther FOCN Intake Form How did you hear about the Farmers of Color Network?RAFI-USA WebsiteSocial MediaAnother FarmerOther Other: What services do you most need/ are you most interested in? Check all that applyFarm VisitInfrastructureMarket AccessSocial MediaFarm AdvocacyEstate Plan / Land TransferLand AccessGrants / LoansUSDA Programs InfoFarmer HealthPolicyCo-op SupportGen FOCN InfoCOVID-19 SupportOther [Optional] What three main goals that you have for the farm business in the next few years? [Optional] What infrastructure is needed to meet your production goals? ( ie., fencing, well, tool storage, etc.) [Optional] What are ways that RAFI could play a role in helping to achieve the vision for the farm? Please be specific... [Optional] What are ways that RAFI could play a role in supporting a network of Farmers of Color needs across the South and Southeast? [Optional] Are you experiencing any immediate crisis (i.e. financial distress, health issues, etc.)? Contact Information
