APPLICATION AND QUALIFICATION QUESTIONNAIRE

APPLICATION AND QUALIFICATION QUESTIONNAIRE

(Agricultural or Pasture)
Mahi Pono reserves the right to select tenants based upon the best value for the Ag Park’s goals. This is an application and qualification questionnaire only. Mahi Pono is not obligated to award a lease to you as a result of this submittal. Sub-leases are prohibited. Please complete all questions and submit completed application form, including all required attachments.
Are you a U.S. Citizen?

YesNo
If not a citizen, what is your status?
Resident in the State of Hawaii since:

MonthDayYear
Date
If you are a U.S. citizen and have resided in the State of Hawaii for less than three (3) years or a permanent status alien and have resided in the State of Hawaii for less than five (5) years, you do not meet the eligibility requirement to hold a Mahi Pono lease. STOP HERE, DO NOT COMPLETE THIS APPLICATION!

If Applicant is not an individual (i.e., Applicant is an entity, such as a partnership, corporation, limited liability company, etc.), all of its associates, partners, stockholders, officers and directors, and LLC members, as applicable, must complete an Application and Qualification Questionnaire; and seventy-five percent (75%) of the associates, partners, stockholders, officers and directors, and LLC members, as applicable, must meet the individual qualification requirements.
Do you intend to farm as a business of for subsistence?

Business- intend to farm for profitSubsistence- intend to farm for subsistence living (Only eligible for 2 acre parcels)

Part II: Qualification and Experience
10. Indicate experience to qualify as a bona fide farmer.
a. Has the Applicant spent minimum four years, full-time, infarming operation, or has been a farm tenant or farm laborer?

YesNo
b. Does the Applicant have an education experience in agriculture, horticulture, floriculture, Mari culture, or aquaculture?

YesNo
If Yes, please explain:
c. Is the Applicant an individual who is displaced from employment in an agricultural production enterprise?

YesNo
If Yes, please explain:
11. Education and Training

a. List all vocational training, business, trade, college or university, graduate or professional schools (for partnerships, joint ventures, or corporations, indicate name of principal or manager for which the education applies):

	Name & Location of School (and Name of person, if applicable)	Field of Study	Degree Type	Date Received
1.
2.
3.
4.

12. This applies only to for profit applicants. If you are applying for subsistence please skip this section and go to 14.

In chronological order, starting with the Applicant’s most current experience, briefly describe Applicant’s farming/ranching experience and business experience (management, financial and marketing) as it relates to the land intended to be awarded. For partnerships, joint ventures and corporations, include both experience of business entity itself as well as experience of principals or managers. Copy and attach additional sheets as needed.
Business Name
Business Address

Street Address

Street Address Line 2

CityState

Zip Code
From:
To:
Accomplishments:
Duties Preformed:
Business Name
Business Address

Street Address

Street Address Line 2

CityState

Zip Code
From:
To:
Accomplishments:
Duties Preformed:
13. Attach at least two (2) reference letters from people, who are not related to you, verifying agricultural background (applies to farm laborer or previous farm experience).

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14. Explain below why you are interested in pursuing an agriculture farm lease:

Part III: Business Plan
Complete one Business plan for the parcel you intend to apply for (copy and attach additional plans as needed).

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15. Preferred Lot Size

2-Acre Lot5-Acre Lot10-Acre Lot
16. What will the land be used for? List the goals and objectives to utilize and develop the land:
17. Attach a location map showing a preliminary sketch, configuration or plot plan of your proposed lease land area in relation to a tax map plat.

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18. What is Applicant's estimated water needs (in gallons per day)?
19. What products will be sold or grown for subsistence?
20. How will you develop the land from the beginning until it is in full operation? Give estimated times required by each major activity. (Your projection must show full development within the two years.)
21. How will you finance the operations?
22. List the type(s) and amount(s) of insurance coverage applicant presently has for Applicant’s business (if any).
23. What problems are anticipated in carrying out this plan and how will you resolve them?

Part IV: Criminal History
1. Have you ever been convicted of a crime of cruelty to animals and/or have you been convicted of any other violation of law?

YesNo
If Yes, please explain:
The undersigned Applicant hereby certifies that the statements and information contained in this Application and Questionnaire, including all attachments, are true and accurate to the best of Applicant’s knowledge and understand that if any statements are shown to be false or misrepresented, Applicant may be disqualified from a lease.

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Applicant Name
By:
Its:
Date

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Date
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