Scholarships will be awarded on a rolling basis until funds expire. We will notify recipients within a week following scholarship application submission. Please double check that you enter your phone number and email correctly so we can contact you. Your Information First Name * Last Name * Business / Farm Street Address City Zip Code State Phone * Email * I am a(n): (check all that apply) Farmer Farm employee (do not own or manage your own farm) Beginning farmer (0-10 years) Aspiring farmer (not currently farming) Home gardener Nonprofit representative Community or school gardener University representative Food-based entrepreneur and/or culinary professional Ag resource personnel (ACES, NRCS, etc) Farmers market manager Government representative Established farmer (10+ years) Food hub representative Farm supplier / industry representative Student Health care professional Broker/buyer Local farm lover / customer Advocate Certified Organic Producer What is your date of birth: MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Year Gender: Race/Ethnicity (check all that apply) White / European-American Black / African-American Latino / Latina / Latinx Hispanic Native American / Indigenous Asian Hawaiian / Pacific Islander other Application Questions Why do you want to attend the Forum? How will attending the Forum improve your farm, project, and/or community? * If you are a farmer, please briefly describe your farm operation, including what you are producing, at what scale, using what methods, etc., and how you market your products. If you are not yet farming, please describe your farm experience and aspirations. * Scholarship Request Are you attending the Adult Food and Farm Forum or the Youth Food and Farm Forum? Adult Food and Farm Forum ($75 for early-bird registration and $85 after October 15th) Youth Food and Farm Forum ($50) What nights will you need lodging? (Shared lodging-$20/person/night) Thursday Night Friday Night Saturday Night How much total scholarship money are you requesting? * $Participants are asked to cover as much of their expenses as possible, to enable us to stretch our dollars further and help more people attend the Forum. Is there anything else you want us to know? Thank you for applying for a scholarship to the 2018 ASAN Food and Farm Forum. We will follow up with you about our decision shortly. Regardless of our decision, further action is required of you once you hear back from us. This is NOT the event registration form. If you receive a scholarship and plan to attend the Forum, you are required to fill out the registration and lodging forms. If you are a youth participant you must also complete waiver(s), media release form, and any other form required of you. If you do not receive a scholarship and choose not to attend you must notify us of your decision. Scholarships will be granted based on a combination of factors, accounting for need, potential food system development/benefit, and overall diversity (ethnicity/race, geographic, professional, and otherwise) of Forum participants. If you have any questions, please contact alice@asanonline.org or 256-743-0742. ASAN is committed to doing as much as we possibly can, with the resources we have. Scholarship applicants are also encouraged to explore other forms of potential community support: will your organization, business, faith community, or a local civic group sponsor you to attend, if you offer to share what you learn with the group when you return? Get creative! Submit
