Grain Coalition Application Grain Coalition Application 1234 All Together Now PA: Grain Coalition ApplicationAdvocating local ownership. Building regional supply chains. Seeking justice and regeneration.Name First Last Email* Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyChoose OneAdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkI don't live in PennsylvaniaMobile PhoneWhat are your social media handles? (If any) Were you referred by a member of the coalition? If so, whom? DemographicsWhat are your preferred pronouns? She/her He/His They/their Ze/zir What is your age group? 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+ What is your race? Asian Black or African American Native American or American Indian Native Hawaiian or Other Pacific Islander White Multiple Races Prefer Not to Answer What is your ethnicity? Hispanic or Latinx Not Hispanic or Latinx Relationship to GrainWhat is your relationship to grain? (Select the one that applies the most.)* Retailer Grain Farmer Miller Grain Farmer & Miller Food/Beverage Producer Maltster Grain Educator/Researcher/Student Local Food Advocate Other RetailerBusiness Name Business address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website What is your business role? Majority Owner Minority Partner/Owner Employee Please briefly describe your business in one or two sentences; including your primary goods sold:What distance do you live from your business? Less than 5 miles 6 - 25 miles 26 - 50 miles 51+ miles Do you currently buy locally-grown grains? Yes No No, however I would like to How do you select vendors? Do you have established criteria for vendor selection?Where are your customers located? Within the region near your business location Within the state Within the northeast region Nationwide Globally Online distribution Are you interested in developing more customers within your region and within our state? Yes No Grain FarmerFarm Name Farm address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your farm role? Majority Owner Minority Partner/Owner Employee Do you own or lease the cropland you farm? Own All Lease All Mostly Own; Lease Some Mostly Lease; Own Some Own & Lease about Equally What distance do you live from the majority of your cropland? Less than 5 miles 6 - 25 miles 26 - 50 miles 51+ miles Cropland Counties (If multiple counties, please list all and note which is the principal cropland county)Approximately how many acres of cropland do you farm? 1 - 9 Acres 10 - 49 Acres 50 - 179 Acres 180 - 499 Acres 500 - 999 Acres 1,000 + Acres What grains do you grow for sale?How would you define your growing practices? (check all that apply) Conventional Certified Organic Organic practices but not certified Good Agricultural Practices (GAP) Verified Good Handling Practices (GHP) Verified Regenerative practices MillerMill address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyChoose OneAdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkI don't live in PennsylvaniaWhat is your business role? Majority Owner Minority Partner/Owner Employee What grains do you mill? (If multiple, please list all and note which are primary)What is your mill's total capacity? At what capacity is your mill currently functioning? Idle Capacity (Not current operating) Below Normal Capacity Normal Capacity Maximum Capacity From how many farmers do you source grain? 1-5 4-10 11-20 20+ Where are the farmers you work with located? 100% Local (Within 25 miles AND in either the same or neighboring county of mill) Primarily Local (75% of the farmers are within 25 miles or in the same/neighboring county of mill) Local & Non-local (Approximately even mix) Primarily Non-local (More than 51% is non-local) Unknown In what states/counties are the farmers you work with located, primarily? What are the primary ways you sell your products? Direct to Consumer In-person (e.g., Farmers markets, Farm Stands, Community Supported Ag)? Direct to Consumer Online (e.g., Online Order & Pick-up/Delivery) Wholesale to Restaurants Wholesale to Food/Beverage Producers Wholesale to Supermarkets/Grocery Stores (do NOT consider Co-ops) Wholesale to Food Co-operatives Wholesale to Schools, Universities, Hospitals, Prisons/Jails Non-Edible Grains - Wholesale to Local Grain Elevator or Business Non-Edible Grains - Wholesale to Local Farmers Production/Marketing Contract Other Please explain the other ways you sell your products: What is your distribution process? (i.e., how does your grain get to the point of sale)Grain Farmer & MillerFarm & Mill Name(s) Mill address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your farm & mill role? Majority owner Minority owner Employee Do you own or lease the cropland you farm? Own All Lease All Mostly Own; Lease Some Mostly Lease; Own Some Own & Lease about Equally What distance do you live from the majority of your cropland? Less than 5 miles 6 - 25 miles 26 - 50 miles 51+ miles Cropland Counties (If multiple counties, please list all and note which is the principal cropland county)Approximately how many acres of cropland do you farm? 1 - 9 Acres 10 - 49 Acres 50 - 179 Acres 180 - 499 Acres 500 - 999 Acres 1,000 + Acres What grains do you grow?How would you define your growing practices? (check all that apply) Conventional Certified Organic Organic practices but not certified Good Agricultural Practices (GAP) Verified Good Handling Practices (GHP) Verified Do you own grain harvesting and seed cleaning equipment? Yes - I own all of the farming equipment I use No - I borrow or lease the farming equipment I use Yes/No - I own some of the equipment I use, while sharing, borrowing, or leasing the rest What grains do you mill?What is your mill's total capacity?From how many farmers do you source grain? 1 - I only mill my own grains 2-5 6-10 11-20 20+ What are the primary ways you sell your products? Direct to Consumer In-person (e.g., Farmers markets, Farm Stands, Community Supported Ag)? Direct to Consumer Online (e.g., Online Order & Pick-up/Delivery) Wholesale to Restaurants Wholesale to Food/Beverage Producers Wholesale to Supermarkets/Grocery Stores (do NOT consider Co-ops) Wholesale to Food Co-operatives Wholesale to Schools, Universities, Hospitals, Prisons/Jails Non-Edible Grains - Wholesale to Local Grain Elevator or Business Non-Edible Grains - Wholesale to Local Farmers Production/Marketing Contract Other Please explain the other ways you sell your products: What is your distribution process? (i.e., how does your grain get to the point of sale)Do you farm other agricultural crops/products/livestock? If yes, please describe below:Food/Beverage ProducerBusiness Name Business address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website What is your business role? Majority owner Minority owner Employee What type of food/beverage production does your business do? 100% Food Production 100% Beverage Production Primarily Food Production (> 60% of production) Primarily Beverage Production (> 60% of production) Both Food & Beverage Production (About Equal) What products do you make? (Please list all and specify which are primary)What percentage of the grain/flour used do you locally source? 0% < 25% 26 - 50% 51 - 75% 76 - 100% Unknown Are there other ingredients in your products that you locally source? If yes, please specify:What is your business production capacity? At what capacity is your business currently functioning? Idle Capacity (Not current operating) Below Normal Capacity Normal Capacity Maximum Capacity What are the primary ways you sell your products? Direct to Consumer In-person (e.g., Farmers markets, Farm Stands, Community Supported Ag)? Direct to Consumer Online (e.g., Online Order & Pick-up/Delivery) Wholesale to Restaurants Wholesale to Supermarkets/Grocery Stores (do NOT consider Co-ops) Wholesale to Food Co-operatives Wholesale to Schools, Universities, Hospitals, Prisons/Jails Production/Marketing Contract Other Please explain the other ways you sell your products: What is your distribution process? (i.e., how does your product get to the point of sale)MaltsterBusiness Name Business address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website What is your business role? Majority owner Minority owner Employee From how many farmers do you source grain? 1-5 6-10 11-20 20+ Where are the farmers you work with located? 100% Local (Within 25 miles AND in either the same or neighboring county of mill) Primarily Local (75% of the farmers are within 25 miles or in the same/neighboring county of mill) Local & Non-local (Approximately even mix) Primarily Non-local (More than 51% is non-local) Unknown In what states/counties are the farmers you work with located, primarily? What are the primary ways you sell your products? Direct to Consumer In-person (e.g., Farmers markets, Farm Stands, Community Supported Ag)? Direct to Consumer Online (e.g., Online Order & Pick-up/Delivery) Wholesale to Restaurants Wholesale to Food/Beverage Producers Wholesale to Supermarkets/Grocery Stores (do NOT consider Co-ops) Wholesale to Food Co-operatives Wholesale to Schools, Universities, Hospitals, Prisons/Jails Production/Marketing Contract Other Please explain the other ways you sell your products: What is your distribution process? (i.e., how does your grain get to the point of sale)Grain Educator/Researcher/StudentWith what institution do you work? What role(s) describes you? (Check all that apply) Educator Researcher Student Other Please explain your other role(s): What are your current research/educational focuses, related to grains and other agricultural product?Historically, what were your research/educational focuses, related to grains and other agricultural product?Local Food AdvocateAre you affiliated with any advocacy groups or organizations? If yes, please describe below.What are your primary local food advocacy goals? (Personally or Institutionally)In what ways are you advocating for local food supplies and/or would like to do more advocacy?Other Relationship to GrainPlease describe your relationship to grain and how you wish to be involved with ATN PA: Alignment of ValuesThe PA Grain Coalition, a program of All Together Now seeks alignment of our members around basic values in order to work collaboratively toward creating the world we want to live in and pass on to future generations. Please provide your values and beliefs to each of the following core areas.We support the local production of our basic needs, such as food, fuel and fiber, by locally owned farms and businesses in order to build community wealth and local economic power. Are you with us? Yes No Maybe Please share your values and beliefs in regards to the above.We work to decrease our reliance on long-distant corporate supply chains in order to increase regional self-reliance and resiliency. Are you with us? Yes No Maybe Please share your values and beliefs in regards to the above.We value economic justice and work to build an inclusive economy that provides opportunity for economically marginalized communities, such as small farmers, immigrants, entrepreneurs of color, women, veterans and returning citizens, in both rural and urban communities. Are you with us? Yes No Maybe Please share your values and beliefs in regards to the above.We believe that exit strategies should be designed to maintain local independent ownership of farms and businesses as much as possible. This can be done by selling to employees, family members, other local entrepreneurs or farmers, or to a community land trust or non-profit, as opposed to selling to large out-of-state corporations. Do you agree? Strongly agree Agree Neutral Disagree Strongly disagree Please share your values and beliefs in regards to the above.We work to build a conscious economy where business decisions are not made to maximize profits and material gain, but to maximize the health and well-being of our communities and eco-systems, while making a fair profit. Are you with us? Yes No Maybe Please share your values and beliefs in regards to the above.We believe that business relationships should reflect the values of cooperation, generosity, fairness, integrity, compassion, and respect for all people, nature and other species. Do you agree? Strongly agree Agree Neutral Disagree Strongly disagree Please share your values and beliefs in regards to the above.What do you hope to gain from being a part of the coalition? Δ
