Crop Insurance Agent or Loss Adjuster Pilot Project Interest Form

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Please complete this form if you have an interest in participating in the Crop Insurance Agent or Loss Adjustor Pilot Project. Completing a form does not guarantee a place in the project. Completing this form does not obligate you to participate in the project.

email address *

First Name *

Last Name *

Address (Number and Street/Road or P.O. Box) *

Town/City *

State or U.S. territory *

Zip Code *

I identify as

Female

Male

Other

Prefer not to say

Clear selection

I identify as (please check all that apply) *

A farmer/rancher/grower/producer

A farm/ranch/growing operation family member

A non-production agriculture professional

A Military Veteran

A beginning farmer/rancher/grower/producer

Other:

Required

I identify as (please choose all that apply)

African-American, African

Asian-American, Asian

White, European-American, European

Latino/Latina/Latinx-American, Latino/Latina/Latinx, or Hispanic

Native American, Alaskan Native

Hawaiian Native, Other Pacific Islander

Rather not say

If you are a farmer/rancher/grower/producer what year did you start?

Tell us about your farming/ranching/growing/agricultural experience, including any crops & livestock raised.

I am interested in possibly being a

Crop Insurance Agent

Loss Adjuster

Either

Unsure

Clear selection

Do you have any questions that you need answered?

Any other comments?

This material is funded in partnership by USDA, Risk Management Agency,

under award number RMA22CPT0012772

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