Native American Carbon Alliance Producer Interest Form

1
Your name* This field is required.
First Name
Last Name
2
Farm or ranch name
3
Cell number* This field is required.
Please enter a valid phone number.
4
Email* This field is required.
example@example.com
5
County where the land is* This field is required.
Please Select
Please Select
Adair
Alfalfa
Atoka
Beaver
Beckham
Blaine
Bryan
Caddo
Canadian
Carter
Cherokee
Choctaw
Cimarron
Cleveland
Coal
Comanche
Cotton
Craig
Creek
Custer
Delaware
Dewey
Ellis
Garfield
Garvin
Grady
Grant
Greer
Harmon
Harper
Haskell
Hughes
Jackson
Jefferson
Johnston
Kay
Kingfisher
Kiowa
Latimer
Le Flore
Lincoln
Logan
Love
Major
Marshall
Mayes
McClain
McCurtain
McIntosh
Murray
Muskogee
Noble
Nowata
Okfuskee
Oklahoma
Okmulgee
Osage
Ottawa
Pawnee
Payne
Pittsburg
Pontotoc
Pottawatomie
Pushmataha
Roger Mills
Rogers
Seminole
Sequoyah
Stephens
Texas County
Tillman
Tulsa
Wagoner
Washington
Washita
Woods
Woodward
I'm in Texas, not Oklahoma
Other state
6
About how many acres would you consider putting into a soil health practice?
Under 40
40 to 100
100 to 250
250 to 500
Over 500
Not sure yet
7
Do you own this ground, lease it, or both?
I own it
I lease it
Both
8
Is the landowner someone you could get a signature from?
Yes
Probably
That could be difficult
9
What do you grow or run?
Row crops
Wheat or small grains
Hay or forage
Cattle
Other livestock
Pasture or rangeland
Timber or woodland
Something else
10
Anything else about the operation we should know?
11
Is the operation in your own name, or in a business?
My own name
An LLC
A partnership
A trust
A corporation
Not sure
12
About how many owners or members?
Just me
2 to 3
4 to 6
More than 6
13
Do you have a farm number with the Farm Service Agency?
Yes
No
Not sure
14
Have you used EQIP or another NRCS conservation program before?
Yes
No
Not sure
15
Roughly how much, if you happen to know?
Under $50,000
$50,000 to $150,000
$150,000 to $300,000
More than $300,000
No idea
16
Do any of USDA's categories apply to you?
I am a member of a federally recognized tribe
American Indian or Alaska Native
Black or African American
Hispanic
Asian or Asian American
Native Hawaiian or other Pacific Islander
I have been farming or ranching 10 years or less
I am a military veteran
My farm income is modest and I may qualify as limited resource
None of these apply
I would rather not answer
17
How soon could you see doing work on this ground?
As soon as possible
Next year
Within 2 to 3 years
Just exploring
18
How did you hear about us?
Native Health Matters
Another producer
A tribal office
An NRCS or FSA office
A meeting or event
Online
Other
19
Is it okay for us to contact you about conservation programs?* This field is required.
Yes
No
20
ACREAGE_FIT
21
ACREAGE_LARGE
22
LEASE_RISK
23
PRIOR_EQIP
24
CAP_CHECK_NEEDED
25
HU_LIKELY
26
TRIBAL
27
MULTI_OWNER
28
NO_FSA_RECORD
29
OUT_OF_STATE
Should be Empty: