Georgia Landowner Academy Application

Applicant #1 Information *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Applicant #2 Information

If additional applicants, please attached separate sheets with their information.

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Property Address *

If you have more than one property, please list the information regarding the other property(ies) in the text box at the bottom of this form.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How is the property currently being used? *

Residential

Farming

Forestry/Growing Timber

Livestock Grazing

Wildlife/Hunting

Recreation

Small Business

Commercial/Industrial Use

Vacant/Wild Lands

Other

How would you like to use the property in the future? *

Residential

Farming

Forestry/Growing Timber

Livestock Grazing

Wildlife/Hunting

Recreation

Small Business

Commercial/Industrial Use

Vacant/Wild Lands

Other

If your land includes a house, does the house/well/septic need repairs?

Yes

No

What is the date that the most recent deed was executed? *

MM

DD

YYYY

Landowner Academy participants can receive assistance creating a will. Would you like assistance with estate planning (i.e. getting a will)? *

Yes

No

Do you have a written management plan for your property? *

Yes

No

How familiar are you with the services offered by the USDA Natural Resources Conservation Services (NRCS)? *

I use or have used services from this agency.

I am very familiar with the services this agency offers.

I know little about the services this agency offers.

I know nothing about the services this agency offers.

How familiar are you with the services offered by the USDA Farm Service Agency (FSA)? *

I use or have used services from this agency.

I am very familiar with the services this agency offers.

I know little about the services this agency offers.

I know nothing about the services this agency offers.

How familiar are you with the services provided by the USDA Rural Development? *

I use or have used services from this agency.

I am very familiar with the services this agency offers.

I know little about the services this agency offers.

I know nothing about the services this agency offers.

How familiar are you with the services offered by the Georgia Forestry Commission? *

I use or have used services from this agency.

I am very familiar with the services this agency offers.

I know little about the services this agency offers.

I know nothing about the services this agency offers.

How familiar are you with the services offered by the Fort Valley State University Extension? *

I use or have used services from this agency.

I am very familiar with the services this agency offers.

I know little about the services this agency offers.

I know nothing about the services this agency offers.

How familiar are you with the services offered by the University of Georgia Extension? *

I use or have used services from this agency.

I am very familiar with the services this agency offers.

I know little about the services this agency offers.

I know nothing about the services this agency offers.

Do you have a USDA Farm Number? *

Yes

No

If yes, have you updated your information with the USDA in the last 5 years?

Yes

No

How skilled are you with using the Internet? *

Highly Skilled

Skilled

Not Skilled

How skilled are you with using Word/WordPerfect? *

Highly Skilled

Skilled

Not Skilled

How skilled are you with using Excel/QuattroPro? *

Highly Skilled

Skilled

Not Skilled

How skilled are you with using Quickbooks? *

Highly Skilled

Skilled

Not Skilled

Will you be able to attend all 6 sessions? *

The sessions are February 26th, March 5th, March 26th, April 9th, April 23rd and May 7th.

Yes

No