Funding provided by USDA NIFA Renewable Resources Extension Act and 1890 Capacity Building Programs

Please complete this form to register for the Fayetteville Earth Day Tree Planting event which will take place on Tuesday, April 24, at the New Roots Community Farm.  This event is in partnership with the WV Tree Minders certification program.
 
Please dress appropriately for the weather and bring your own gardening or work gloves. Tools will be provided. For more information, please contact Extension Agent Liz Moss at elizabeth.moss@wvstateu.edu or (304) 661-6016
or Dina Hornbaker at dina@newrootscommunityfarm.com.
 
Thank you for completing this form. The information collected is used as part of our evaluation process for funding purposes and to assist us to provide you with quality educational programs. Information that is collected is held in the strictest confidence and is not disseminated. WVSU Research and Development Corp. is an Equal Opportunity/Affirmative Action Employer and does not discriminate against any person because of race, sex, age, color, religion, national origin or disabilities.

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* 1. What is your name?

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* 2. What is your gender?

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* 3. In what year were you born?

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* 5. What is your contact information? 
Please at least provide a working email so you can receive updates about any changes to training dates or times, due to weather.

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* 6. Which race/ethnicity best describes you? (Please choose only one.)

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* 7. Are you of Hispanic or Latinx origin or descent?

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* 8. What is your military status?

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* 9. Have you operated a farm or ranch for more than 10 consecutive years?

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* 10. Where do you currently reside?

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* 11. What is your approximate household income bracket?

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* 12. Was your Total Household Income for each of the last two years less han $25,100?

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* 13. Do you have a disability?

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* 14. We strive to host accessible events that enable individuals of all abilities to engage fully. Do you need any accommodations in order to participate (such as captioning, large print documents, translation services, or others)?

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