EOEEA-AGR

Consent

Yes, I would like to allow MDAR to share my contact information with organizations that receive funding from MDAR grant opportunities to connect with and expand market opportunities for socially disadvantaged farmers. I understand that opting-in may result in receiving phone calls or emails from organizations looking to purchase product from my business, but does not guarantee purchase of product from my business.

1. First Name(Required)

2. Last Name(Required)

3. Farm or Business Name(Required)

4. Email Address(Required)

5. Phone Number(Required)

6. Mailing Address

Street Address Address Line 2 City State ZIP Code

7. Farm or Business Location:

Same as above

Farm or Business Location:(Required)

Street Address Address Line 2 City State ZIP Code

8. What products does your farm produce? Please select all that apply:

Apiary

Aquaculture

Beef cattle

Cranberries

Dairy products

Fruits (not cranberries)

Maple

Nursery and landscaping products

Small livestock

Vegetables

Hay

Other

8 b. Other

9. Does this describe you?

This answer is optional. This information will not in any way affect your eligibility for MDAR programs and is used for statistical purposes only.

Limited Resource Farmer

10. What is your preferred method of communication?

Phone

Text

Regular Mail

Other

11. MDAR seeks to expand its communication methods to farmers. Please share, how do you receive agricultural news and updates?

Community-based organization

Non-English Print Media

Radio

Other

11 b. Other

If you selected Community-based organization, please describe:

If you selected Non-English Print Media, please describe:

If you selected Radio, please describe:

12. Please indicate below if you prefer to communicate in a language other than English?

These answers are optional. This information will not in any way affect your eligibility for MDAR programs and is used for statistical purposes only.

Yes

If yes, which language to you prefer to communicate in?

13. What types of services and/or resources from MDAR are you most interested in learning more about?

Grants Technical Assistance Courses Offered

Other

14. If you feel this form did not offer the opportunity to self-identify, please let us know here. I am a historically underserved farmer/producer by way of: