Producer Enrollment

USDA CLIMATE SMART GRANT

PRODUCER ENROLLMENT APPLICATION

First Name *

Last Name *

Street Address *

City *

State *

Farm/Ranch County: *

Zip Code *

Phone Number *

Email Address *

Please list the grazing season (in months), type of land grazed, and number of acres included in your farm operation?

EXAMPLES:

April – October Irrigated Pasture 20 acres

November-March Rangeland 40 acres

January – March Vineyard Cover Crop 10 acres

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Do you qualify as an underserved producer based on USDA’s definition? Underserved producers include beginning farmers, socially disadvantaged farmers, veteran farmers, limited resource farmers, and women farmers. *

Do you qualify as a small producer? The USDA defines a small farm as an operation that has a gross cash farm income (GCFI) of less than $250,000, and enough land or livestock to generate at least $1,000 in sales. *

What is your history in the sheep industry/how long have you been raising sheep? *

Why do you want to enroll in the Climate Smart program? *

Which of the following climate-smart practices are you interested in implementing? (check all that apply) (Note: If selected for funding, you will have the opportunity to discuss and receive advice from a Technical Assistance Provider before finalizing the practices you agree to implement).

	Choose all that apply
Prescribed Grazing (USDA NRCS Practice 528)	Choose all that apply
Cover Crop (USDA NRCS Practice 340)	Choose all that apply
Pest Management Conservation System (USDA NRCS Practice 595)	Choose all that apply
Brush Management (USDA NRCS Practice 314)	Choose all that apply
Silvopasture (USDA NRCS Practice 381)	Choose all that apply
Fence (USDA NRCS Practice 382)	Choose all that apply
Range Planting (USDA NRCS Practice 550)	Choose all that apply
Tree/Shrub Establishment (USDA NRCS Practice 612)	Choose all that apply

Do you agree to all the program requirements listed below?

Establish Farm Records with the USDA Farm Service Agency
Complete an AD-2047 (Customer Data Worksheet to facilitate the collection of customer data for Business Partner Record)
Certify highly erodible land conservation and wetland conservation via Form AD-1026
Certify that they are not a foreign person
Certify that they are not receiving funds for the same practices on the same acreage from other government programs such as EQIP
Share farm data to calculate emissions, and to calculate carbon sequestration associated with implemented climate-smart management practices (data will be aggregated with all the other ALB program numbers)

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