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Farm Stewardship Application
Name
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
How did you hear about us?
*
Social Media
Event
Google Search
From a Friend/Word of Mouth
Other
Age
*
Preferred Pronouns
*
Male (He/His)
Female (She/Hers)
Other (They/Them)
Prefer not to discuss
What is your annual household income
*
We ask this for our records and reports only. You personalized info will not be shared outside of our organization and your answer will not affect your application.
How many people like in your household?
*
Why are you interested in participating in this program?
*
Do you have any experience with gardening or farming?
*
Yes
No
If yes, at what capacity?
*
What do you hope to learn from this program?
*
What is your experience working outside doing physical work?
*
Do you have issues with working in all weather conditions?
*
Yes
No
Do you have reliable transportation to our farm at 3188 S 1100 W?
*
Yes
No
What days and hours are you available to complete the 5 hours of hands on learning in the Farm Stewardship?
*
Which option do you want to participate in:
Full Season
Spring Module
Summer Module
Fall Module
Additional Comments
Information Summary