Architectural Services Technical Assistance Request Form - Agricultural Marketing Service - Usda

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Architectural Services Technical Assistance Request Form

Request Date:

Fiscal year:

FY2020 (10/19-9/20)

Made by

Lead Organization:

Coop

Religious

State Government

Local Government

Non-Profit

Private Citizen

Corporate

CSA

Project Location:

City:

Address:

State:

County:

Zip Code(s):

Current Census Population:

TOTAL:

Main Point of Contact

(must be available for duration of project to lead coordination of local participation and interact with the planning assistance team)

First Name:

Last Name:

Organization Affiliation:

Coop

Religious

State Government

Local Government

Non-Profit

Corporate

CSA

Private Citizen

Position/Title:

Phone #:

Email:

Fax #:

Type of assistance requested:

(select those that apply)

Technical Assistance

USDA Farmers Market

Food Value Chain and Food Hubs

Wholesale Market and Facility Design

Commercial Kitchen

Business Incubator

Community Planning

Community Garden

Other (please identify)

Funding Source:

(select those that apply)

Government

State

County

City

Town

Community

Grant

Local General Fund

Tax Revenue

Tenant(s)/Lease

Corporate

Community Supported Agriculture (CSA)

Donation(s)

Other:

Private

Project Scope

(detail all aspects):

Please provide detailed information in regards to local food impact, community impact, number of farmers/vendors, geographical area serviced, etc. Provide seperate sheet if needed.