1. Name of farm: (required)

2. Farmer's/Farm Family name: (required)

3. Street address:

4. City:

5. State (2-letter abbreviation):
ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY

6. Zip:

7. Phone number:

8. Email (required)

9. Website:

Type of Farm/Farm Practices

10. Are you Certified Organic?
YesNo

11. Are you Certified Biodynamic?
YesNo

12. If you are not Certified Organic, do you use organic production methods?
YesNo

13. Do you use synthetic fertilizers?
YesNo

14. Do you use any of the following: nonorganic pesticides, herbicides, parasiticides, or fungicides?
YesNo

Animal Husbandry

15. Do you keep livestock?
YesNo
(If No, skip to question 37)

16. What animals do you keep?

Chickens (list breeds):

Ducks (list breeds):

Turkeys (list breeds):

Other Poultry (list type and breeds):

Cows (list breeds):

Goats (list breeds):

Pigs (list breeds):

Sheep (list breeds):

Other Animals (list type and breeds):

17. Do you use antibiotics?
YesNo

18. Are the animals pasture-fed?
YesNo

19. How much and for how long:

20. Do you practice managed grazing?
YesNo

21. Do you apply compost or compost tea?
YesNo

22. Do you apply other soil amendments?
YesNo

23. Do you use supplemental feed?

For poultry (list type):

For cows, sheep, and/or goats (list type):

For pigs (list type):

Raw Milk

24. Do you supply raw milk?
YesNo
(If No, skip to question 34)

25. Do you keep your barn and milk room clean?
YesNo

26. Do you keep the cows clean/teats washed?
YesNo

27. Do you thoroughly wash your milking equipment after every milking?
YesNo

28. Are cows with mastitis or other health problems excluded from milking?
YesNo

29. Are cows tested for disease?
YesNo

Which tests, and how often?

30. Is the milk routinely tested for pathogens, coliform count?
YesNo

Which tests, and how often?

31. Is the farm water routinely tested?
YesNo

32. Are milk and milk products kept well chilled?
YesNo

33. Other/Explain (list any other routine practices, or explain any of your answers above?

Butchering Practices

34. Do you sell milk?
YesNo
If No, skip to question 38)

35. Meat butchered at a USDA-certified or state-certified abattoir?
YesNo

36. Meat butchered on the farm?
YesNo

37. Describe or explain any butchering practices:

Farm Products

38. Please check off the products you sell and list current prices

Raw whole milk:

Raw butter:

Raw cream:

Raw ice cream:

Raw sour cream:

Raw yogurt:

Raw kefir:

Raw cottage cheese:

Whey:

Cheese (list types):

Other dairy (list):

Beef/veal:

Pork:

Goat/kid:

Mutton/lamb:

Other meat:

Chicken:

Duck:

Turkey:

Other poultry:

Eggs (list type, chicken, duck, etc) :

Honey:

Produce (list typical offerings):

Prepared foods (list typical offerings):

Other:

Additional Information

39. Do you only sell animals that are raised on your farm at the address listed?
YesNo

39a. Provide any details you want:

40. Are the animals born on your farm at the address listed?
YesNo

40a. Provide any details you want:

41. Do you ever purchase animals from auctions or from your processor or do you ever buy parts from your processor (whole pork bellies...)?
YesNo

41a. Provide any details you want:

42. Do you personally attend to your animals at least once a day or do you hire help or farmers to do that for you?
Personally AttendHire Help

42a. Provide any details you want:

43. Do you purchase pre-mixed feed from an elevator or do you grind your own?
PurchaseGrind Own

43a. Provide any details you want:

44. Where can customers find you? (check all that apply):
On FarmFarmers MarketsDrops in certain areas

44a. Provide any details or comments you want: