Advancing the Seed, Inc. Workshop Intake Form

Advancing the Seed, Inc. Workshop Intake Form
WORKSHOP YOU WILL ATTEND*
Name*

First NameLast Name
Email*
example@example.com
We are also collecting a few demographic details (age range, income, and zip code) to better understand the general public we serve.
Age Range*
Income Range*

Under $20,000$20,000–$34,999$35,000–$49,999$50,000–$74,999$75,000–$99,999$100,000 and above
Zip Code*
Do you have any questions you would like us to cover during the workshop?
Community Release of Information Consent
I understand that Advancing the Seed, Inc. collects certain personal and demographic information to provide services, coordinate support, and meet program reporting requirements. By checking this box, I consent to Advancing the Seed, Inc. sharing the information I provide in this form—including my business structure, age range, income range, ZIP code, and any questions I submit—with JCOD and its authorized partners.

I acknowledge that this information may be used for reporting, data analysis, service coordination, and program evaluation to improve community services. I also understand that my information will only be shared with JCOD-approved partners directly involved in supporting or evaluating the program.

Advancing the Seed, Inc. will protect my information in accordance with all applicable privacy and confidentiality laws. My data will not be sold, used for marketing purposes, or shared with anyone outside the approved partners described above. I understand that I may request additional details about how my data is used and may withdraw my consent at any time, except where the data has already been included in required reports.
I have read and understand the Release of Information statement, and I give my consent for Advancing the Seed, Inc. to share my information with JCOD and its approved partners.
After submitting this form, you will be redirected to the appropriate Zoom registration link based on the workshop you select
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Advancing the Seed, Inc. Workshop Intake Form

We are also collecting a few demographic details (age range, income, and zip code) to better understand the general public we serve.

Community Release of Information Consent