Farmer Veteran Coalition Registration Form
Please fill out the following form to register with FVC. Everyone is welcome to register- veteran or not. Once you have completed this, you will be signed up for our monthly eBlast and receive our Farmer Veteran Coalition Resource Guide. Thank you!
Questions marked with a red asterisk are required in order to successfully submit this form.
First Name
Last Name
Mailing Street
Mailing Country
Please select...
United States
Other
Mailing Country Other
Mailing City
Mailing State / Province
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
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
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Mailing Zip/Postal Code
Phone
Please enter phone number in the following format: 123-456-7890
Email
Birthdate
Please enter as: MM/DD/YYYY
Gender
Male
Female
Prefer Not to Answer
Race / Ethnicity
Please select...
African American / Black
Asian
Caucasian / White
Hispanic / Latino
Middle Eastern
Native American
Pacific Islander
Other
Prefer Not to Answer
Current Profession
Are you a veteran or military member?
Yes
No
Have you served in the Armed Forces?
Military Service Questions
Current Military Status
Currently Serving
Separated
Retired
Military Branch
Air Force
Army
Coast Guard
Marine
Navy
Other
Type of Service
Active Duty
National Guard / Reserves
Date of Service Entry
Please enter as: MM/DD/YYYY
Date of Separation (If still serving, leave blank)
Please enter as: MM/DD/YYYY
Do you have a service-connected disability?
Yes
No
Did you serve after September 11, 2001?
Yes
No
In your time of service, did you deploy?
Yes
No
Deployment Information
Number of Deployments
Please select...
1
2
3
4
5
6
7
8
9 +
0
Location of Deployments
Desert Storm
OIF
OEF
Vietnam
Other
Location of Deployment (if Other)
Are you currently involved in agriculture?
Yes
No
Which of these most accurately describes your involvement in agriculture?
I am an employee, student, intern or volunteer who is involved in agriculture
I own an agriculture business such as a farm, food hub or processing facility
I work in agriculture such as an Extension Agent, USDA, FSA, AgriAbility, FarmCredit, etc.
None of the above
Please tell us about your current involvement in agriculture:
The Agriculture Business I own:
Farm / Ranch / Fisheries
Processor
Distribution
Other
Please tell us about the work that you do, below:
Please describe how you are involved in agriculture, below:
Agriculture Business name:
Website or Facebook Page:
Which products apply to your Agriculture Business? (Please check all that apply):
Poultry
Row Crops
Field Crops
Fruit Trees
Nut Trees
Flowers
Berries
Grapes
Bees
Fish / Shellfish
Lumber
Other
Beef
Pork
Dairy
Aquaponics
Hydroponics
Horses
Other Livestock
What is currently grown (other)
How many acres do you work?
Please select...
>0 to 5
5 to 10
10 to 20
20 to 50
50 to 100
100+
0 Acres
Exact Number of Acres
Do you Own or Lease your facility/property
Own
Lease
Please tell us about your Farm / Ranch / Fishery:
Please check all of the boxes that apply:
Urban Farmer
Conventional/Sustainable
Certified Organic
What do you process? Please check all that apply:
Value Added Products
Fiber
Other Agricultural Products
Is your processing facility on your farm?
Yes
No
Please describe the products that you process below:
What do you distribute?
Ag Products
Other Products
Where do you distribute?
Nationally
Locally (within the state or 275 miles)
Please describe what you distribute below:
Please tell us about your agriculture business below:
Have you been involved in agriculture in the past?
Yes
No
Please describe your past involvement in agriculture:
Are you interested in owning an agriculture business such as a farm, food hub or processing facility?
Yes
No
Please describe in as much detail as possible, what steps you have already taken:
Would you like assistance in job-readiness preparation? (This is for individuals not seeking ownership in farming/ranching.)
Yes
No
Would you like to make a donation to the Farmer Veteran Coalition? (Donations may be: monetary, equipment, supplies, etc.)
Yes
Not at this time
Donation Questions
What type of donation would you like to make to the Farmer Veteran Coalition?
Monetary
Heavy Equipment (tractor, trailer, etc.)
Supplies (seeds, shovels, fertilizer, etc.)
Land
Other
Please describe the donation that you would like to make to FVC:
Would you like to be involved with the Farmer Veteran Coalition? (Involvement may be: offering a veteran a job, promoting FVC at local events, offering services, etc.)
Yes
Not at this time
Supporter Questions
I can offer a Job or Internship to a Farmer Veteran
Yes
No
Please briefly describe the job or internship that you can offer:
I would like to promote FVC in my area (Please ensure that you have entered your location details above)
Yes
No
I would like to share my knowledge, skills and expertise with Farmer Veterans
Yes
No
Please describe your area(s) of expertise:
I can offer services/resources in:
Financial
Agricultural
Veteran Services
Business, Marketing or Legal
Other
If other, please specify:
How did you learn of FVC?
Please select...
Online
Social Media
Media
Friend / Family / Colleague
Farm Organization
Conference / Workshop / Retreat
Veteran / Government Organization
Other
How I learned of FVC (other)
You will automatically be added to our email list when you click Submit.
Thank you!
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