Producer Intake Form

General Information

This is an initial survey that is being used to gather benchmark information about your new or current farm operation

Name*

First Last

Farm Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

Farming Experience

1. What is your farm related background?*

I do not come from a farm background, and I have little or no knowledge or hands-on experience.
I do not come from a farm background, but I have farming experience and knowledge.
I grew up on a farm.

2. Please choose the statement that most closely matches your beginning farmer or rancher status.*

Prospective or explorer farmer: Individuals interested in starting a farm or ranch. This includes next-generation farm family members as well as those who do not come from a farming background.
Startup Farmer: Individuals who are in the early stages of their agricultural operation.
Re-strategizing farmer: Farmers who are making changes to their operations after an initial period of farming. These individuals usually have increased decision-making responsibility and commitment to farming.
Establishing Farmer: Farmers who are expanding, diversifying, and stabilizing their farming operations.
Transitioning Farmer: Individuals who are family farm members who have decision-making roles on the farm without having primary farm operator status. Also referred to as heritage farmers.
Urban Grower

3. Please indicate how many years you have farmed or have been farming (Please select one)*

0 years
1-5 years
6-10 years

4. What type(s) of agricultural enterprise are you currently interested in/involved with? (Check all that apply)

(Check all that apply)

Other: What type(s) of agricultural enterprise are you currently interested in/involved with?*

Farm Business Planning and Management

For the following questions, please indicate your level of disagreement or agreement with each statement.

I know the pieces necessary for developing a farm business plan*

I know how to plan and keep good business records*

I feel confident in my ability to apply for FSA or other loans*

Have you developed a business plan for your farm business?*

Yes
No

What is your business structure?

Family Farm
Sole Proprietorship
Partnership
Limited Liability Company (LLC)
Corporation
S-Corporation
Nonprofit Corporation
Other

Other: What is your business structure?*

Have you applied for FSA or other loans?*

Yes
No

If yes, list type*

Do you participate in any USDA (FSA, NRCS, RD, ETC.) programs and VDACS programs?*

Yes
No

If yes, list which ones*

Including yourself, how many people will provide labor for your farming operation?*

Please enter a number

How many hours per week is this labor available?*

Please enter a number

Is this labor available daily or only on weekends?*

Daily
Weekends Only

Do you have any knowledge of your farming equipment needs?*

Yes
No

If yes, explain.*

What is your net profit goal each year from farming?*

$0 - $999
$1,000 - $4,999
$5,000 – $9,999
$10,000 or more

What are your financial plans to begin your farming operation?

Use Personal Funds
Secure a startup loan

(Check both if applicable)

Production Practices

I know my options for alternative, environmentally friendly production practices*

I feel confident in my ability to operate small farm tools and equipment*

Marketing

Please indicate the market outlets you currently utilize or plan to utilize. (Check all that apply)*

Other (List)*

Approximately how many miles away is your primary market or intended market? (Please select one)*

I sell/intend to sell my products at my farm
0-15 miles
16-25 miles
26-49 miles
50-100 miles
101-150 miles
151-200 miles
200+ miles
Do not know/Have not decided

Do you sell or intend to sell your farm products directly to consumers (i.e. not through a third party)?*

Yes
No

I know about markets in my area that I can/do utilize to sell my farm products

For the following questions, please indicate your level of disagreement or agreement.

I know how to find new markets to sell my farm products

For the following questions, please indicate your level of disagreement or agreement.

I know about value added farm products and which products I can utilize in my farm business

For the following questions, please indicate your level of disagreement or agreement.

I know about food safety techniques and government rules and regulations regarding food safety

For the following questions, please indicate your level of disagreement or agreement.

Land Access

Select type of land you have or plan to acquire

Farmland
Forrest

(Check both if applicable)

Do you currently own, rent or plan to have farmland transferred to you?

Own
Rent
Plan to acquire land

If yes, how many acres do you currently have/manage or plan to acquire?

None (planning to farm)
Less than 2
2-5
6-10
11-20
21-50
51-100
101-200
Over 200

Is there a pond, lake or any other water source on the property?

Yes
No

How many acres of forestry land do you own?

Demographic Information

Please check all that applies to you:

Demographic Information

Please check all that applies to you

Limited resource: A limited resource person is a person with direct or indirect gross farm sales not more than $180,300 (for FY2020) in each of the previous two years. A person with a total household income at or below the national poverty level for a family of four or less than 50 percent of county median household income in each of the previous two years.
Small Farmer: An operation with gross cash farm income under $250,000
Farm worker: An individual who contributes to the labor of the farm but does not owner/operator status.
Male farmer: A farmer who identifies self as a male operator
Female farmer: A farmer who identifies self as a female operator.
Urban Grower

Please check the category or categories that best describe(s) you.

Check all that apply

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
Spanish, Hispanic, or Latino Origin
White
Other race(s)

Other race(s)*

What is your age range?*

What is your gender?

Male
Female
Prefer not to say

U.S. Military Veteran Status: Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard?*

Yes
No

Which branch of military did you serve?*

Army
Air Force
Navy
Marine Corps
Coast Guard

Personal Goals

(check all that apply)

What are your goals for participation in this program?*

Additional Information

Please provide any additional information that you would like to share with us

Acknowledgement*

The information I have provided in this New, Re-strategizing Farmers / Rancher benchmark evaluation Program entry evaluation document is true and accurate. By signing this document, I hereby acknowledge that I will participate in the agricultural education programs provided by Virginia State University (VSU) Small Farm Outreach Program (SFOP) and work with the Small Farm Program Assistants in my area. I grant VSU SFOP permission to assist me with the outreach, training, technical assistance that is needed to develop, implement and improve my farming operation.