Maine Senior FarmShare Program New Farm Participation Request Form Question Title * 1. Farm Contact Information Owner Name Farm Name Mailing Address Farm Location City/Town State/Province -- 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 ZIP/Postal Code Email Address Phone Number OK Question Title * 2. Can your farm consistently offer a minimum of 5 different produce items at designated farm, farmers' market, or other site at any time for a minimum of 8 consecutive weeks? Yes No OK Question Title * 3. Will your farm offer delivery of shares to seniors? (NOT REQUIRED) Yes No OK Question Title * 4. What was the total acreage in fruit and vegetable production during 2018 for your farm? OK Question Title * 5. Do you currently accept WIC Farmers' Market Nutrition Program checks? Yes No OK Question Title * 6. Do you currently accept Supplemental Nutrition Assistance Program transactions? Yes No OK Question Title * 7. How many years of farming experience do you have? OK Question Title * 8. Does your farm currently offer a Community Supported Agriculture (CSA) program? Yes No OK Question Title * 9. How did you learn about the Maine Senior FarmShare Program? Maine.gov website Get Real Get Maine website A participating farm Newspaper A senior citizen Other (please specify) OK Question Title * 10. How do you currently market your produce? (Check all that apply) Farm Farm Stand Farmers' Market CSA Other (please specify) OK Question Title * 11. Have you participated in the Maine Senior FarmShare Program in the past? Yes No OK Question Title * 12. Are you able to provide three professional references? Yes No OK Thank you for your interest, the Maine Senior FarmShare will respond to your request within 5 business days. OK SUBMIT