Technical Assistance Request Form Question Title * 1. Contact Information (Required.) Name * Title Address City/Town * State * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming County ZIP/Postal Code Email Address * Phone Number * Question Title * 2. Please select the category that best represents you: Academics-Professor / Professional Ag. Land Owner, not operator Ag Organization Staff Attorney, Financial Planner, Realtor, Appraiser, Banker Citizen Activist / Concerned Citizen Consultant Cooperative Extension Staff Environmental Organization Staff Farmer (specify Farmer Type in following question) Federal Agency Staff (other than USDA) Land Trust Staff Lawmaker Local Gov't Official and Employee Media NRCS and other USDA agencies staff Planner Private Foundation Staff State Agencies - Conservation Staff Student Other (please specify) Question Title * 3. Please specify Farmer Type Beginning Farmer (10 or fewer years of experience) Ag Landowner / Operator Question Title * 4. Enter your request here: Question Title * 5. Request Purpose Develop education materials / curriculum Develop or amend a federal policy / program Develop or amend a state or local policy / program Enhance farm/ranch profitability Support farm legacy Inform land protection decision Inform spatial analyses Learn about conservation practices Participation in a farmland protection program Prepare proposal Start up or expand operation Transfer land or business Other (please specify) Question Title * 6. How did you hear about us? American Farmland Trust Staff American Farmland Trust Website Farmland Information Center Educational Materials Farmland Information Center Website Mailings / Newsletters, etc. Media Coverage National Agricultural Land Network Personal Referral Other (please specify) Done
