BIPOC Farmer Mini-Grant Application: 2022

ABOUT YOU

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* 1. Your Contact Information

First & Last Name (Nombre y Apellido) *

Farm Name (if applicable) (Nombre de su Granja)

Address (Dirrecion) *

Address 2 (Dirrecion)

City/Town (Cuidad/Pueblo) *

State (Estado) *

ZIP Code (Cogido Postal) *

Farm/Business Website or Facebook Page: (Pagina de web de su negocio)

Email Address (Correo Electronico) *

Phone Number (Numero de telefono) *

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* 2. Please select the race/ethnicity that best describes you. (Please choose only one or provide more information in the Other field.)
(Por favor seleccione su raza y etnia, que mejor lo indentifica)

Indigenous / American Indian or Alaskan Native (Indigena / Indio Americano o nativo de Alaska)

Asian / Pacific Islander (Isleno asiatico / pacifico)

Black or African American (Negro o afroamericano)

Hispanic / Latino/a/x (hispano o latino)

White / Caucasian (Blanco / Caucasico)

Multiple race/ethnicity / Other (please specify)
(Multiple raza)

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* 3. What gender best describes you? (Que genero te describe mejor)

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* 4. Please select the option that best describes you: (Por favor, seleccione la opción que mejor le describe)

Certified Organic Farm (Granja Certificada Organica)

Farm actively in the transition to certified organic (Granja activamente en la transición a la certificación orgánica)

Aspiring Organic Farmer (interested in apprenticeship/ internship/ or training to become certified organic farmer) *(Aspirante a agricultor orgánico (interesado en aprendizaje / pasantía / o capacitación para convertirse en agricultor orgánico certificado)

Other (please explain) (Otro- Por favor explique)

BIPOC Farmer Mini-Grant Application: 2022

ABOUT YOU

Question Title

* 1. Your Contact Information

Question Title

* 2. Please select the race/ethnicity that best describes you. (Please choose only one or provide more information in the Other field.)(Por favor seleccione su raza y etnia, que mejor lo indentifica)

Question Title

* 3. What gender best describes you? (Que genero te describe mejor)

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* 4. Please select the option that best describes you: (Por favor, seleccione la opción que mejor le describe)

Question Title

* 5. Requested Grant Amount (not to exceed $2,000) (Monto de la subvención solicitada - no exceder los $2,000)

* 2. Please select the race/ethnicity that best describes you. (Please choose only one or provide more information in the Other field.)
(Por favor seleccione su raza y etnia, que mejor lo indentifica)