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, Farmers of Color Network Director, ray@rafiusa.org

Farmer Contact Information

First Name

Last Name

Mobile Phone Number

Home/Alternate Phone Number

Email Address

Street Address

City

State

Postal Code

County

Farmer Information Cont'd

Are you actively farming?

YesPreviously but not currentlyNoI am an aspiring farmer

Race

Black/African AmericanLatinxNative AmericanAsian Multiracial/BiracialWhiteOther (Please describe)

Other:

Gender

FemaleMaleNon-BinaryOther

Other:

Birthdate

What year did you begin farming?

Are you a veteran?

YesNo

What is your preferred language?

EnglishSpanishHaitian CreoleOther

Other Language

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

State

Postal Code

County

Your Farm's Website

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/HydroponicsBeesCattleCommoditiesConventionalEggsFiberFish / SeafoodFlowersForestryFruitGoatsHempHerbsHogsHorticultureLarge-ScaleMid-ScaleNutsOrchardOrganicPoultry - ContractPoultry - IndependentSheepSmall-ScaleValue 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 Certified

Year GAP Certified

Certified Organic

Year Certified Organic

Certified Naturally Grown

Year Certified Naturally Grown

Certified Humane

Year Certified Humane

Animal Welfare Approved

Year Animal Welfare Approved

Food Justice Certified

Year Food Justice Certified

B-Corp

Year Certified B-Corp

Other

Other Certification

Year of Other Certification

Were you previously certified and/or do you follow organic practices?

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?

Do you have a clear title to the land?

YesNo

Do you own or manage the land where you farm? Select all that apply.

Personally ownOwned by a legal entity (ex: LLC)Manage land with a lease or other formal agreementManage land without a lease or other formal agreementOther

Other

What is the land ownership status? Are there any heirs or property issues?

Do you have estate planning assistance needs?

YesNo

What are your 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?

Internet SearchRAFI-USA WebsitePartner OrganizationSocial MediaConferenceAnother Farmer/Word of MouthOther

Other:

What services do you most need/ are you most interested in? Check all that apply

Farm VisitInfrastructureMarket AccessSocial MediaFarm AdvocacyEstate Plan / Land TransferLand AccessGrants / LoansUSDA Programs InfoFarmer HealthPolicyCo-op SupportGen FOCN InfoCOVID-19 SupportOther

What three main goals that you have for the farm business in the next few years?

What infrastructure is needed to meet your production goals? ( ie., fencing, well, tool storage, etc.)

What are ways that RAFI could play a role in helping to achieve the vision for the farm? Please be specific...

What are ways that RAFI could play a role in supporting a network of Farmers of Color needs across the South and Southeast?

Are you experiencing any immediate crisis (i.e. financial distress, health issues, etc.)?