Personal Information:

Name(Required)
Mailing Address(Required)
Email Address(Required)
Note: Only residents from specific counties are eligible for this award. If your county is not listed, please do not select another county as an alternate.

Educational Information:

I am enrolled or plan to enroll as an Occupational Continuing Education Student.(Required)
The program must be at least 96 hours long.

Other Information:

Have members of your immediate family worked for or owned a farming or agricultural related business now or in the past?(Required)
Have you or members of your immediate family been employed in traditional industries such as furniture, textiles, or tobacco manufacturing?(Required)
Has anyone in your household lost their job in the past two years?(Required)
Has anyone in your household transitioned from a full-time job to a part-time job?(Required)

Use of Funds:

Select the category or categories you are requesting funding for.(Required)