Farmer Intake Form

Farm information: First, please tell us about your farm and how you found us.

Farm Name

Farm City or Town

Primary Farm Sector

Beef

Field crops / Grain drying

Maple

Small Fruit / Orchard

Poultry

Swine

Vegetable

Vineyard

How did you hear about this project?

Newsletter

Phone Call

Email Listserve

Farm visit

Website

Texting

Online meeting or webinar

In person workshop or meeting

Requesting consultation: Let us know if you'd like to be contacted directly. If so, we will reach out to discuss energy efficiency on your farm and opportunities for a no-cost, no-commitment energy assessment in collaboration with NYSERDA.

Are you interested in someone from our team contacting you directly to discuss energy efficiency on your farm?

Yes, please!

Maybe sometime in the future.

If yes, what is the best time to contact you?

If not, could you tell us why?

Receiving program broadcasts: You can opt-in to receive announcements from Ag Energy NY about resources, opportunities, and incentives for energy efficiency in agriculture. We will only send you program updates if you check one of the boxes requesting them.

Please send me emails about program updates and new opportunities

Please send me text messages about program updates and new opportunities

Farmer and contact information: Let us know who you are. If you opted to receive program updates or be contacted about farm-specific energy efficiency, let us know how to contact you.

First Name

Last Name

Phone

Optional self-identification: Completion of the following questions is voluntary and helps us achieve our goals as equal opportunity educators.

Do you consider yourself to be Hispanic/Latino?

Hispanic/Latino (including Spain)

In addition, please select one or more of the following racial categories to describe yourself:

American Indian or Alaskan Native (including all Original Peoples of the Americas)

Asian (including Indian subcontinent, Pakistan, and Philippines)

Black or African American (including Africa and Caribbean)

Native Hawaiian or Other Pacific Islander (Original Peoples)

White (including the Middle East and North Africa)

Form submission: If you are a farmer, please disregard the fields below. Scroll to the bottom of this form and and click the buttons for "I'm not a robot" and "Submit".

If you are an extension agent helping complete this form for a farmer, please enter your information here:

Educator Name

Educator Email

Thank you for your interest in best energy practices for agriculture. We are excited to help you reach energy efficiency goals and save energy costs on your farm!

Submit