Request for Services
Case Origin
Case Priority
Case Record Type Name - this may be changed in Salesforce via flow on submit of the form
Contact Information
First Name
Last Name
Are you actively farming?
Yes
Previously but not currently
No
I am an aspiring farmer
Mobile Phone Number
Home/Alternate Phone Number
Email Address
Street Address
Those with a complete mailing address on file will receive a copy of RAFI-USA's triannual magazine, Living Roots.
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
N/A
PR
VI
DC
Postal Code
County
Demographic Information
This demographic information is used for data and evaluation purposes only. It is not required to fill out but it does help us improve our services and connect you with demographic-specific opportunities.
Race
Black/African American
Latinx
Native American
Asian
Multiracial/Biracial
White
Other
Other:
Gender
Female
Male
Non-Binary
Other
Other:
Birthdate
Preferred Language
English
Spanish
Other
Other:
Farm Information
Farm Name
If your farm doesn't have a name, please enter [Your Name] Farm
Type of Farm: Check all that apply
Agritourism
Aquaculture
Aquaponics/Hydroponics
Bees
Cattle
Commodities
Poultry - Contract
Poultry - Independent
Conventional
Eggs
Fiber
Fish / Seafood
Flowers
Forestry
Fruit
Goats
Hemp
Herbs
Hogs
Horticulture
Large-Scale
Mid-Scale
Nuts
Orchard
Organic
Sheep
Small-Scale
Value Added
Vegetable
Vermiculture
Other
Other:
Total Acres in Production
Acres Owned
Acres Leased
Does your farm have a Farm ID?
Yes
No
Services Requested
Farm Financial Crisis and Advocate Services
Resources for Aspiring or Beginning Farmers
Access Disaster Relief or Recovery Programs
Resources for BIPOC Farmers
Assistance with Market Access and Farm Marketing
Funding for Farms: Loans, Grants, Credit, etc
Conservation, NRCS Programs, Climate Smart Ag Practices
SNAP Retailer Certification and Training
Connecting with faith communities
Other
Services Requested
Farm Financial Crisis and Advocate Services
Resources for Aspiring or Beginning Farmers
Access Disaster Relief or Recovery Programs
Resources for BIPOC Farmers
Assistance with Market Access and Farm Marketing
Funding for Farms: Loans, Grants, Credit, etc
Conservation, NRCS Programs, Climate Smart Ag Practices
SNAP Retailer Certification and Training
Other
Services Requested
Farm Financial Crisis and Advocate Services
Resources for Aspiring or Beginning Farmers
Access Disaster Relief or Recovery Programs
Other
What do you need assistance with? Provide as much detail as possible.
How did you hear about RAFI-USA?
Internet Search
Rafi-USA Website
Partner Organization
Social Media
Conference
Another Farmer/Word of Mouth
Other
Other:
Contact Information