Enroll in AgrAbility Enrollment Form Please fill out the information as best as you can. An AgrAbility staff member will call or email to follow up on your enrollment and discuss any questions we have. First and Last Name* Spouse Name If under the age of 18, please name a guardian in this section.Email Address Best Phone Numbers* Please include a home phone and/or cell phoneDate of Birth* Gender*MaleFemaleEthnicity*CaucasianAfrican AmericanNative AmericanAsianHispanicOtherAre you a Veteran?*YesNoIf yes, years served Farm Address* The specific address where the farm is located. Include County. Example: 1234 Creek Rd, Delavan, WI 53115 Walworth CountyCounty* Please list the county your farm is located in. Mailing Address This is not required if you live at the farm address. Farm Position*Owner/ OperatorSpouse/ PartnerDependent AdultChild (Dependent under the age of 18)EmployeeBeginning FarmerInterested in FarmingMigrant WorkerSeasonal WorkerNo longer farming, but interested in continuing to farmYears in Business* What year did you start farming? Did you take over the farm from your parents/ family member?Work Status*Full TimePart TimeOccasionallyNot currently working on the farmFarm Businesses*Please explain what is all included in the farm. How many acres you are running, any crops and animals on the farm, and any other agriculture businesses you have on the farm. Limitations*Explain what's not working. Are you having trouble with your arthritis acting up or not able to get in and out of tractors? If you had an injury, tell us the year it happened and any surgeries or continued therapy. INCLUDE AS MUCH DETAIL AS YOU CAN. Δ
