Dairy Improvement Grants Program

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Page 1

A. APPLICANT AND FARM INFORMATION

Applicants

First Name

Last Name

Farm Name

Business Address

Business Mailing Address (street)

Town

State

Zip

Telephone

Website

Physical Farm Address-if different from above

Physical Address (street)

Town

State

Zip

Have you participated in the Vermont Farm & Forest Viability Program?

YesNo

When and who was your business advisor?

The farm is a member of :

St. AlbansCo-Operative CreameryDairy Farmers of America

Please provide financial information for Jan. 1, 2016 - Dec. 31, 2016

Gross Farm Income: $

Please enter with commas and a decimal point, if needed.

Net Farm Income: $

Gross payroll: $

Please enter with commas and a decimal point, if needed.

Net worth (as of Dec 31, 2016, or from most recent balance sheet): $

Gross income from milk sales: $

Please give current number of:

Cows milked daily	Fulltime family laborers (incl self)
Milking per day	Part time family laborers
Rolling herd average	Fulltime non-family laborers
Pounds milk shipped per year	Part time/seasonal non-family
Average cull rate
Acres in crop production	Raw count/standard plate count
Acres in pasture	Somatic cell count

Page 2

B. GRANT REQUEST

Please provide a Project Title and brief description, and how much funding you are requesting. See application instructions for directions on eligible uses of funds and matching funds.

Project Tile:

Project Description (1-3 sentences):

Grant Funding Request: $

Please enter with commas and a decimal point, if needed.

Match Funding Amount: $

Please enter with commas and a decimal point, if needed.

Sharing your application: Can we forward your application to other funders, such as USDA NRCS or the Vermont Agency of Agriculture, if they have applicable funding available?

YesNo

Page 3

C. NARRATIVE QUESTIONS

Please answer the following narrative questions. The spaces below each question will scroll to fit your response, and are capped at about one page or 4000 characters.

1. Overview of Farm Business - Please provide basic description of your farm business, including brief overview of your farm, number of cows, volume of milk produced, other on-farm products, production practices, acreage used, farm management (you may use the same language from your business plan.

2. Proposed Project Description - Please describe the proposed project for which you are now seeking assistance.

3. Other funding or match -Are there any state or federal grants your project would be eligible for, such as the Agency of Agriculture’s Best Management Practices funding or NRCS EQIP funds? If so, have you talked with any staff at those organizations, or other technical assistance providers such as the Association of Conservation Districts, about your project?

4. Project Outcomes, Benefits and Impacts - What are the outcomes that you expect from this project? How will it benefit your farm, your family, your community? In particular, please address how the project will impact milk production and farm viability. Please express impacts in terms of profitability, productivity, return on investment, viability, quality of life and/or other specific outcomes.

5. Need for a Dairy Improvement Grant - Describe how this project would go differently without being awarded a grant. Would the project happen more slowly, in a less desirable fashion, or with a lower potential fro success? Would you complete this project as described, with or without the grant?

6. Project Timeline - Please provide an estimated timeline for the project

7. Compliance with regulations - If the purpose of this project is to help you meet new water quality rules, or to help you comply with other state regulations, please explain how the project will help you meet regulations. If not, you do not need to answer this question.

8. Contingencies and Permits - Please list any other applications or processes upon which your project is contingent (i.e., other grants or bank loans, engineering). Please list any federal, state, or local permits or approvals that will be necessary for you to implement this project, and the status of these applications or processes. If engineering may be needed, tell us where you are in the process of getting the designs, and who you are working with to accomplish this.

Page 4

ATTACHMENTS

Confidentiality & Signature: By submitting your application materials, you agree to allow your business plan and application materials to be read by members of the Farm Viability Board Review Committee and by staff of the Vermont Housing and Conservation Board in accordance with our program's Confidentiality Policy. No other persons will have access to your business plan, and all copies will be collected for safekeeping following the meeting of the Review Committee.

Please type your name(s) below to agree to the following:
The information provided in this application and all attachments is true to the best of my (our) knowledge. I (we) agree to allow the above-mentioned committee and staff members to read our application.

Enter Name

Name:

Date

_________________________________________________________________________________________________________

1. Business Plan (required)

See page 5 of the instructions packet for business plan requirements.

Upload your Business Plan here:

2. Financial Statements (required)

The financial statements are critical, and will be kept confidential. Please do not submit tax returns unless you do not track your income and expenses any other way. If you need to submit tax returns, please black out your social security or EIN number.

a. Current Balance Sheet: a snap-shot of financial condition showing assets and liabilities

REQUIRED: 2016 year-end or current balance sheet

OPTIONAL: previous years’ balance sheets

b. Historical Income Statement: a listing of farm income and farm expenses (also known as Profit &Loss)

REQUIRED: 2016 (or most recent historical income statement)

OPTIONAL: previous 1-3 years’ income statements

c. Cash-flow Projection or Budget for 2017: typical monthly projections of the movement of cash into (payments received the business) and out of (payments made) the business; should take into account income and expenses that affect cash available. Projections beyond 2017 are welcome but optional.

Upload your financial statements here, either as one attachment that includes all the required statements, or as several attachments.

Upload your Financial Statements here (unless they are already included in your business plan):

3. Budget Sheet (required)

Complete the budget sheet with the full costs of the project, making sure to show that you will be contributing matching funds that are equal to or more than the grant amount you are requesting. You can download the blank budget sheet from the Dairy Improvement Grants Web Page

Upload your Budget Sheet here:

4. Photos (optional)

Include or attach up to five photographs or maps to show the water quality issue you are addressing or the solution you plan to implement.

Upload your Photos here:

5. Support letter/s (required in some cases)

If you are receiving funds from another source such as NRCS or the Vermont Agency of Agriculture, attach a letter showing their commitment to the project. If the purpose of the project is to fix a water quality issue or comply with other state/federal regulations, it will be very helpful to attach a letter of support from any technical advisor or state employee who is assisting you with the project.

Upload your Support letter here:

Prior to submitting this application, you must provide your email address if you want to receive a PDF of this completed form with your responses. Please provide your email address:

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