Name of Farm, Company, or Organization:___
Contact Person for Project: Mr./Ms.
Mailing Address:___
Town/City: ___ County: ___ State: ___ Zip Code: ___
Farm Address (if different from above): ___
Town/City: ___ County: ___ State: ___ Zip Code: ___
Phone: Email address: ___
Social Security Number or Federal Tax ID Number: ___ FSA farm number: ___
How did you learn about this grant program? _____
Is your gross farm income more than $1,000 and less than $250,000 per year? ___Yes ___No
Is your net household income less than $23,000 per year? ___ Yes ___ No
Have you received KADF cost share funds from your county in the past five years? ___Yes ___No
Is this a new enterprise for you? ___ Yes ___ No
Are you a beginning farmer (two years or less)? ___ Yes ___ No
Do you currently produce tobacco? ___ Yes ___ No
Have you produced tobacco in the last 10 years? ___Yes ___No
Is your operation certified? Organic Transitional Exempt Certifying Agency:_____
Is this educational training out of the state of Kentucky? ___ Yes ___ No
Are you a military veteran? ___ Yes ___ No
Workshop Title (attach event agenda): ___
Description of the requested educational training (please provide available links to the training or conference):
Training Date(s): ___
Location:___
Who will attend and receive the training? ___
Who will write and submit the post-training report?___