Disaster Relief Application
Internal Setup Only
Contact ID
Account ID
Current Member:
Yes
No
Farm Found?
Yes
No
Contact Found?
Yes
No
Expiration Date:
Contact Information
First Name
Last Name
Farm Name:
Email:
Phone:
Mailing Address
City
State
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
Postal Code
County (begin typing to select county):
Demographics
CFSA is committed to serving and reflecting the diversity of the food system in the Carolinas. We use demographic data to measure our progress towards this commitment. Your responses won’t determine your eligibility for any program, and your individual demographic information will not be shared or made public.
Are you a beginning farmer/rancher, operating a farm/ranch for
less than 10 years
?
Yes
No
Are you a
US Veteran
or
Active Duty
Service Member?
Yes
No
Are you a
limited resource farmer/rancher
?
You can use the
USDA's Limited Resource Farmer/Rancher Self-Determination Tool
if you are unsure.
Yes
No
Which of the following best describes you?
Please select...
Female
Male
Non-Binary
Prefer not to provide
Prefer to self-describe
Self-description:
What is your race or ethnicity?
Please select...
Asian or Asian American
Black or African American
Hispanic, Latinx or Spanish Origin
Middle Eastern or North African
Multi-Racial
Native American or Native Alaskan
Native Hawaiian or Pacific Islander
White or European American
Do not wish to provide
Not listed here or prefer to self-describe
Self-description:
How did you hear about this program?
Social media post
Facebook ad
Post in WNC-focused Facebook group
Email from CFSA
Email from a listserv
Podcast episode
Word of mouth
Other (please describe)
Other:
Damages & Support
Estimated number of your acres affected?
If you grow in a concentrated manner (such as microgreens or mushrooms), please enter a decimal such as 0.1 or 0.5 of an acre.
x
What type of damage and loss did you experience?
Flooding
Loss of topsoil
Deposition of gravel or sediment
Damage to infrastructure (buildings, well, water system, fences, greenhouses, high tunnels, etc.)
Damage to conservation infrastructure (waterways, terraces, diversion ditches, permanently installed ditching systems)
Other, please describe.
Other damages:
What type of technical assistance do you need?
Assessing flood-damaged fields and soil testing
Applying for Farm Service Agency (FSA) or Natural Resource Conservation Service (NRCS) programs
Food safety risk management
Implementing conservation practices
Finding new markets
Other, please describe
Other assistance:
Contact Information