Is this a new enterprise for you?

Box No

Have you been approved for KADF cost share funds from your county in the past five years?

Box Yes

Please mark the statement that best describes your level of tobacco dependency:

□ Prior to 2001, but not since 2001, I grew tobacco or owned a tobacco quota

Since 2001, I have owned quota or grown and marketed tobacco

I have never grown tobacco or owned quota

Did you file a schedule F and/or schedule C (IRS tax forms) in the previous year?

☐ Yes

☐ No

If you responded No to the previous question, please explain:

What percentage of your income comes from your farming/production activities?

[F3] 10 to 25%

□26 to 50% □51 to 75%

Calculation to determine %: (Farm Sales ÷ Income) × 100 = %

□ More than 75%

[Example: $5,000 Farm Sales ÷ $45,000 Income] x 100 = 11.11%]

What other groups are you a member of or affiliated d with? (check all that apply)

Kentucky Proud Farmers Market OAK KAA CFA LFPA Appalachian Proud KDA Organic Program KWIA Grow Appalachia KCARD

Other Programs:

KYSU programs (please list): ___

List the crops you are growing or the livestock that corresponds to the need for grant funding.