AgrAbility Interest Form

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Complete this form in order to indicate your interest in being selected as an AgrAbility Apprentice at Mandy's Farm. Completion of this form does not guarantee registration. Following your form's submission, you will be contacted for further information.

We are currently accepting interest forms for our next cohort cycle which begins February 2024. We will begin contacting and onboarding interested apprentices in Fall of 2023.

Thank you for your interest in being a part of AgrAbility!

I am interested in participating in: *

Apprenticeship (1-3 year training and support)

必填

Please provide the first and last name of the individual who would like to be considered for participation in the AgrAbility program (the applicant, referred to as "you" from here on): *

Please provide the first and last name of the individual completing this form: *

Relationship to applicant: *

Do you have a documented disability? *

Yes

Maybe

What is your preferred language/ form of communication? *

English

Spanish

American Sign Language

Communication Device

其他:

Have you worked with plants in any of the following settings? Check all that apply *

Gardens

Greenhouses or nurseries

Farms

Botanical Gardens

No experience at this time

其他:

必填

Please describe your interest in agriculture/ the AgrAbility program: *

Please provide a phone number for us to update you/ your support network regarding program status: *

Please provide an email address for us to update you/ your support network regarding your enrollment status: (please ensure this email is correct. If an incorrect email is provided, we will not be able to register you) *

Please re-enter your email *

Are you currently accessing any of the following services? *

APS Transition Service

DD Waiver/ Mi Via

DD Waiver Waitlist

Sun Van

Project Search

Supplemental Security Income (SSI)

Medicaid

Supplemental Nutrition Assistance Program (SNAP)

None of these

必填

Are you currently accessing services through the Division of Vocational Rehabilitation? *

Yes

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