Application for Pennsylvania Grazing Lands Coalition Mentorship Contact information First name Last name Street Address City StatePlease select... AL AK AZ AR CA CO CT DE DC 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 Zip code County Primary phone Primary phone typeMobileHomeWork Email address Are you a NRCS employee? YesNo Farm and program goals Does your farm have a name? What size is the farm? If your farm leases land include it in the total acres below.Under 5 acres5 to 50 acres51 to 100 acres101+ acres What is your farms annual gross revenue?Under $10,000$10,000-$50,000$50,001-$100,000$100,000 + Briefly describe your current or planned grazing operation (livestock type, system of management, market, organic, etc). Please state a few of your goals for your farm or specific enterprise. How do you plan to best communicate with your mentor? Keeping records will be used for reporting back to PA GLC regarding the program. Is there any other relevant information or thoughts you'd like to include with your application? Demographic Information We value supporting a diverse participation and creating an welcoming environment for all. The following demographic information helps us reach out to various segments of our community and will not influence the selection process. What is your age?18-29 30-3940-4950-5960-6970+ What is your race/ethnicity?American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinxNative Hawaiian or other Pacific IslanderWhite or CaucasianPrefer not to answer What's your gender?FemaleMaleNon-binaryPrefer to self-describe Prefer to self-describe Contact Information
