Request for Assistance Form
Name
First
Last
Pronouns
Email Address
Preferred Phone
Please select...
Home
Work
Mobile
Other
Home
Work
Other
Mobile
Primary Language (choose one)
Please select...
English
Spanish
Other
Other Language
Please enter language if Primary Language is Other.
Farm Name
Farm Website
Address
Farm Aid’s mission is dedicated to farmers in the United States. Unfortunately, we do not work with farmers and ranchers outside of the United States and U.S. territories and are unable to answer inquiries from other countries.
Street Address
City
State
Please 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
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip/Postal Code
County
Demographics
Please check all that apply.
This information is used for data and evaluation purposes only and to make sure we are adequately and appropriately serving the needs of all farmers; it is not required for you to fill out but it does help us to improve our services.
Male
White
Veteran
Female
Latina / Latino / Latinx
Disabled
Non-Binary
BIPOC (Black, Indigenous, Person of Color)
Immigrant
LGBTQIA+
AAPI (Asian American and Pacific Islander)
Other
Other Demographics
Your Farm
Type of Farm
(check all that apply)
Cotton
Dairy
Flowers
Grain/Oilseed
Livestock
Poultry/Egg
Urban
Vegetable/Fruit
Other
Other Type of Farm
Please specify type of farm.
Size of farm (in acres)
Please choose the range that is the closest to your total acreage farmed, including owned and/or leased land.
Under 5 acres
5 – 24
25 – 49
50 – 99
100 – 499
500 – 999
1000 acres or more
Do you own or lease land?
Own
Lease
Both
Neither
Farming Practice
(check all that apply)
Certified Organic
Sustainable / Regenerative
Transitioning to Organic / Sustainable / Regenerative
Conventional
Other
Other Type of Farming Practice
Please specify the other Farming Practice.
Farming Status
(check all that apply)
Future farmer (not currently farming but trying to)
Beginner farmer (farming for less than 10 years)
Established (10+ years)
Non-farmer
Service provider
Farmworker/ Migrant Worker
Farm Employee
Services Needed
What do you need help or assistance with?
(check all that apply)
Activism & Organizing
Conservation Programs
Crisis Assistance
Direct Marketing Assistance
Disaster Relief/ Resilience
Farm Energy Options
Farm Land Access/ Succession Planning
Farm Stress
Financial & Business Planning
Funding Opportunities for Farmers
Industrial Ag & Factory Farm Issues
Institutional & Wholesale Markets
Legal Help & Mediation Services
Organic/ Sustainable/ Regenerative Transition & Support
Research/Technical Assistance & Education
Resources for Beginning Farmers
Resources for BIPOC Farmers
Resources for Farmers with Disabilities
Resources for Farmworkers
Resources for LGBTQIA Farmers
Resources for Tribal Farmers & Ranchers
Resources for Veteran Farmers
Resources for Women Farmers
What do you need assistance with? Please provide as much detail as possible.
What other organizations have you already connected with or tried to reach out to?
Is there any other information you’d like to share with Farm Aid?
How did you hear about Farm Aid?
(check all that apply)
Another Organization
Concert
Conference
I’ve called the Hotline before
Internet Search
Other
Social Media
Word of Mouth
www.farmaid.org
Contact Information