2) Full Name *

First Name

Last Name

4) Phone *

(###)

###

####

5) Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

7) How do you identify yourself? *

Asian/Asian American

Black/African American/African

Hispanic or Latino/a/x

Native American/American Indian/Alaska Native/Indigenous

Native Hawaiian or Other Pacific Islander

White/Caucasian/European

Prefer not to state

Other ( If other, please specify)

8) What does your farm produce? (check all that apply) *

Fruits (e.g., watermelon, strawberries, cranberries, tree fruit)

Vegetables (e.g., broccoli, peppers, squash, lettuce)

Horticulture (e.g., herbs, flowers, potted plants for sale)

Tree nuts (e.g., almonds, pistachios, walnuts)

Honey

Livestock

Dairy products

Grain (including hemp)

Fungi

Cannabis

Other (please specify)

9) How many acres do you currently farm? *

Fewer than 5 acres

5-20 acres

21-50 acres

51-100 acres

101-200 acres

More than 200 acres

10) Total gross farm revenues in 2024: *

Less than $10K

$10K - $49K

$50K - $99K

$100K - $199K

$200K - $400K

$400k or more

11) In the last 12 months, have you received a California Underserved and Small Producer (CUSP) award? *

Yes

No

13) Please select the extreme weather events that have impacted your farm. (Select all that apply) *

Drought

Wildfire / smoke

Flooding

Extreme heat

Extreme cold / frost / freeze / heavy snow

Hail

Windstorm

Heavy rainstorm

High winds

Other (If other, please specify)

14) In what ways has your farm been impacted by extreme weather? (Select all that apply) *

Crop loss due to extreme weather not related to drought (e.g. heat burn, smoke damage, flood, extreme cold, etc.)

Planted fewer acres or fallowed land

Replacement of crops (including trees, nursery stock, and perennial plants)

Replacement of farm inputs (including feed, fertilizer, compost, and cover crops)

Sales Outlet fluctuation

Infrastructure or equipment damage or loss

Clean up/debris removal costs

Purchase/rental of flood control equipment

Additional equipment expenses

Water/soil testing after flood events

Livestock/beehive loss or increased veterinary or transportation expenses

Biologic pest or animal disease/quarantine

Increased labor costs or expenses (e.g. hazard pay, purchase of personal protective equipment)

Additional land tenure expenses (e.g. relocation, lease payments)

Other (please describe)

15) What do you estimate are the current financial impacts of the extreme weather events on your farm? *

$0 - $4,999

$5,000 - $9,999

$10,000 - $19,999

$20,000 - $49,000

$50,000 or more

17) I have at least one of the documents that illustrates verification of losses. I will include file(s) as part of my application packet (either by email or by uploading directly to this form). Please refer to the CUSP Extreme Weather & Other Climate Impacts Relief Eligible Practices Table. *

Yes

No

Other

20) I would like to be added to ABIRC's mailing list for future updates regarding other grants or opportunities. (Optional)

Yes

No

Certifications (Optional)

I understand the CUSP eligibility requirements and certify that I am eligible for this program.

I certify that I have not received reimbursement from another source for the costs being requested with this application.

I certify the above information is complete, true, and correct to the best of my knowledge. I understand that I may be contacted by a CUSP technical assistance provider to follow up on the missing documentation.