Hero Agriculture Application

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Anissa: 770-548-3088

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Hero Agriculture Application

Yellow fields are required.

First name

Primary phone

Last name

Alternate phone

Name you like to be called

Email

Home address

City

State

Zip code

Who else lives at your residence? Please note whether they are adults or children.

Mailing address, if different from home address

City

State

Zip code

Demographic Information

Birthday

Gender

Military Service

Branch of Service

Rank/Pay Grade

Type of Discharge

Honorable

Administrative

Unknown

Other (please describe)

Year you first entered service

Number of deployments

Farming Aspirations

Are you currently farming?

Yes

No

Years farmed (0 is okay!)

What interests you in Hero Agriculture?

What would be your #1 goal for working with Hero Agriculture?

What do you hope to be doing one year from now?

Who do you know who could help to support you in achieving this goal?

Are there accommodations that could help you while learning to farm? Please explain.

If you own or have access to property where you now farm or plan to farm, please describe it.

How did you learn about Hero Agriculture?

Emergency Information

Emergency contact name

Emergency contact town of residence

Emergency contact phone

Emergency contact relationship to you

Veteran Status Verification

To help Hero Agriculture verify your veteran status, please submit the most recent copy of one or more of the documents below.

*** Please cover your Social Security number and other sensitive information. ***

Discharged or Retired

DD214 showing discharge status
NGB 22 (National Guard)
DD256 (Reserves)
Discharge or Retirement Orders/Certificate (Reserves)

Active Duty

VA Benefits Summary Letter including dates of service and character of discharge
MEB/PEB Narrative Summary
Current Unit Orders to a WTU/WTB as a patient (not cadre)
Line of Duty (LOD) form with memo
Service/Personnel Record (e.g., ERB, ORB, BIR, SURF, EPR) dated within the past 90 days

Files can be pdfs or images (e.g., jpeg, png, heic, gif).

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