Ga Flooded Farms Relief Fund Application

Slow Food®Atlanta Supporting Good, Clean, and Fair Food

Application for Funding - Georgia Flooded Farms Relief Fund The Georgia Flooded Farms Relief Fund was established by Slow Food Atlanta to assist small, sustainable and organic farms that suffered damage during the September 2009 floods. Our mission is to help farmers recover from their flood losses by providing funding, volunteers, and equipment as needed. Slow Food Atlanta believes that everyone has a right to enjoy good, clean and fair food. We believe the food we eat should taste good, that it should be produced in an earth-friendly manner, and that food producers should receive fair compensation for their work. Slow Food Atlanta is a 501(c)3 non-profit organization. For more information, please visit our website at www.slowfoodatlanta.org. Instructions: Please fill in all required fields that are marked with a red asterisk and all other fields where applicable. If you have any questions, please contact Karen Adler at 404-633-4534 or email [email protected]. You may also apply online at www.slowfoodatlanta.org The deadline for all applications is November 8, 2009. Farm Name:* _______________________________________________________________ Farm Owners:* ______________________________________________________________ Farm Address:*______________________________________________________________ ___________________________________________________________________________ Mailing Address (if different from above): _________________________________________ ___________________________________________________________________________ Phone Number(s):* ___________________________________________________________ Email Address:* ______________________________________________________________ In what county is your farm located? * ____________________________________________ Farm Website:________________________________________________________________ Are you a Slow Food Member?*

Yes

No

Have you ever been a Terra Madre delegate?*

Yes

No

Are you a Georgia Organics member?*

Yes

No

What type of farming method are you employing at your farm?* Certified Organic

Certified Naturally Grown

Use Organic Methods, but not certified

Sustainable

Conventional

Other, please specify:_____________________

What is the total size of your farm in acres? *____________________________________ What is the total size of cultivated area at your farm in acres? *______________________ What types of products does your farm produce (please check all that apply)? * Fruit

Meat

Vegetables

Honey

Dairy

Value Added Products (Jams, Sauces, etc.)

Eggs

None of these

How many different types of fruit and vegetables do you grow throughout the year? * None

51-75

1-20

76-100

21-50

100+

What types of livestock are raised at your farm? * Chickens

Lamb/Sheep

Cows

Goats

Pigs

None of these

Turkeys What types of losses did you experience on your farm as a result of the September 2009 floods (please check all that apply)? * Crop Loss

Livestock Loss

Topsoil Loss

Infrastructure Damage (such as irrigation system)

Equipment Damage

Other, please specify:__________________________

Crop Loss - Please answer the following questions if you experienced crop loss as a result of the September 2009 floods: Please estimate the total value of the crops that were lost as a result of the flood: $_____________________ Please estimate the total percentage of crop loss as a result of the flood: ____________% Please provide details about which crops varieties and the quantities that were lost as a result of the floods:____________________________________________________ ___________________________________________________________________ ____________________________________________________________________ Topsoil Loss - Please answer the following questions if you experienced topsoil loss as a result of the September 2009 floods: Please estimate the total cost to replenish the topsoil and/or remediate the soil: $______________________ Please provide further details about your topsoil loss and soil remediation if needed: ____________________________________________________________________ ____________________________________________________________________ Equipment Damage - Please answer the following questions if you experienced equipment damage as a result of the September 2009 floods: Please estimate the total cost of equipment damage to your farm as a result of the flood: $______________________ Please provide further details about your equipment damage and the costs to repair or replace: ___________________________________________________________________ ____________________________________________________________________ Livestock Loss - Please answer the following questions if you experienced livestock loss as a result of the September 2009 floods: Please estimate the total value of your livestock that was lost as a direct result of the flood: $______________________ Please provide further details about your livestock loss and the value of the loss: ___________________________________________________________________ ____________________________________________________________________

Infrastructure Damage - Please answer the following questions if you experienced infrastructure damage as a result of the September 2009 floods: Please estimate the total cost of infrastructure damage to your farm as a result of the flood: $________________________ Please provide further details about your infrastructure damage and the costs to repair or replace: ___________________________________________________________________ ____________________________________________________________________ Loss of Income - Please answer the following questions if have experienced or expect to experience a loss of income as a direct result of the September 2009 floods: Please estimate the total loss of income as a result of the flood: $_________________ Please provide details about your loss of income as a result of the floods: _____________________________________________________________________ _____________________________________________________________________ Insurance Coverage Do you have any type of insurance that will cover any of your losses from the September 2009 floods? * Yes

No

Not Sure, Maybe

If you do have insurance to cover your losses, please answer the following questions: What is your deductible? $_________________________ Please explain what expenses your insurance will cover:__________________________ _______________________________________________________________________ Please estimate the total amount that your insurance will cover: $_______________ Other Assistance Have you applied for aid with any other organization? * Yes

No

I plan to apply in the future

Other Assistance, continued If you have applied or are planning on applying for aid with another organization, please list the organization(s) and how much assistance you applied for: ______________________________________________________________________________ ______________________________________________________________________________ What is the status on your application for aid with other organizations? Approved

Pending

Denied

Not Applicable

Is any other organization or business holding a fundraiser on your behalf or making a donation to your farm? * Yes

No

Maybe in the future

Please estimate the total amount that will be raised on your behalf by other organizations or businesses, if applicable:__________________________________________________________ ______________________________________________________________________________ Georgia Flooded Farms Relief Fund Please check the type of assistance that you are seeking (more than one choice may be selected). * Financial

Equipment to Repair Damage

Volunteers to Work at the Farm

Other, please specify:__________________________

What is the total amount of funding that you would like to request from the GA Flooded Farms Relief Fund? * $_________________ If you are interested in equipment to repair the damage to your farm, please specify the details of what is needed:_________________________________________________________________ ______________________________________________________________________________ If you are seeking volunteers to work at your farm, please estimate how many volunteers and how many work hours will be needed: ______________________________________________ ______________________________________________________________________________

May the committee members of the Georgia Flooded Farms Relief Fund schedule a visit to view your farm? * Yes

No

How do you foresee your losses impacting your production for 2010? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Pictures If you have pictures of the flood damage that occurred at your farm, please send them with your application or email them to [email protected]

By checking this box, I certify the information that I have provided on this application to be true to the best of my knowledge. * Signature:_________________________________________ Date:_____________________

Please mail your application to: Georgia Flooded Farms Relief Fund P.O. Box 2641 Smyrna, GA 30081 You may also scan and email your application to: [email protected].