Enrollment for Hands-on Training in Tree Pruning

Funding provided by USDA NIFA Renewable Resources Extension Act Program

Please complete this form to enroll in an outside tree pruning workshop. Required answers are those regarding dates for training and method of contact. Workshops are limited to 10 participants.

Please dress appropriately for the weather and bring your own gardening or work gloves. Tools will be provided. For more information, please contact Liz Moss at elizabeth.moss@wvstateu.edu or (304) 661-6016. Click HERE for a map of the WVSU campus.

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?

First

Middle

Last

Suffix

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* 2. What is your gender?

Male

Female

Nonbinary (please specify)

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* 3. In what year were you born?

Year (YYYY)

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* 4. 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.

Company / Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

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

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White / Caucasian

More than one race

Other (please specify)

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

Yes, Hispanic or Latinx

No, not Hispanic or Latinx

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* 7. What is your military status?

Veteran

Active

Reserves

Dependent Family Member

No Military Service

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

Yes

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* 9. Where do you currently reside?

Farm

Rural (under 10,000 residents)

Town (10,000 to 50,000 residents)

City (over 50,000 residents)

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* 10. What is your approximate household income bracket?

Less than $9,999

$10,000-$19,999

$20,000-$29,999

$30,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$149,999

$150,000 and up

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

Yes

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* 12. Do you have a disability?

Yes

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* 13. 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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* 14. Please select a hands-on pruning training opportunity.

Saturday, May 15, 2021, 9-11a; Saint Albans High School parking lot

Friday, May 21, 2021, 9-11a; West Virginia State University Curtis Complex (#27 on campus map)

I can't make either date; please contact me if more trainings are available in the near future.

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* 15. How would you like to be contacted regarding updates to these outdoor trainings, such as inclement weather?

text

phone call

Other (please specify)

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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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* 4. 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.

Question Title

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

Question Title

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

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* 7. What is your military status?

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

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* 9. Where do you currently reside?

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* 10. What is your approximate household income bracket?

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

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* 12. Do you have a disability?

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* 13. 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)?

Question Title

* 14. Please select a hands-on pruning training opportunity.

Question Title

* 15. How would you like to be contacted regarding updates to these outdoor trainings, such as inclement weather?

* 4. 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.