CT RC&D FarmUP Intake Form

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Account Registration

First Name *

Last Name *

Farm/Company Name

Email *

Phone 1 *

Farm Address Line 1 *

Farm Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

If mailing address is different from above physical address, please include mailing address in entirety here:

Type of farm operation (greenhouse, field crops, nursery, dairy, beef, livestock, other):

Do you own or lease the land on which your farm is located?

How many acres are on your farm / how many acres are in production?

Years in operation:

Which of the following areas are you most interested in receiving information about or assistance with?

Federal, state, and local resources

Program and funding opportunities

Business development

Marketing/outreach

Other

If you selected "other," please explain:

Anything else you'd like to add that would be pertinent to our initial meeting?

Disclaimer and Signature

Please acknowledge the following disclaimers by reading and typing your name.

I acknowledge that CT RC&D provides assistance to eligible applicants on a first come, first served basis. I certify that my answers are true and complete to the best of my knowledge.

Photos of my farm or any project as a result of FarmUP assistance provided may be used for educational purposes during workshop presentations and/or for website, brochure, or social media purposes by CT RC&D.

In accordance with the reporting requirements of funding agents for this program, CT RC&D will share my farm contact information and information regarding services provided to me.

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Connecticut RC&D
1066 Saybrook Road
PO BOX 70
Haddam, CT 06438
860-345-3977
info@ctrcd.org