Application for  Common Ground Organic Farm 

Name                            
Age     
Birthday

Address and dates you can be reached there      

Phone                                           
e-mail / fax                        

Other address and dates if moving soon:

Phone
email/fax

Please give me an idea of the dates you are available.  What are your 
"ideal" starting / ending dates?  Second choice?


How did you find out about our  program?

Are you currently a student?        
Where?
Tell me about any  jobs or volunteer work you've done that's farm or garden 
related:


Would you have a car while you're here?
Can you drive a vehicle with a standard (manual) transmission?

If you have any allergies or asthma, please explain the type and severity:


Do you have difficulty lifting heavy objects of 30 lbs. or more?


Do you have back problems?  Please explain.


Are you in good health?
Please describe any medical conditions or other disabilities not listed above:


Please explain any experience you've had with the following:*

    Horses:

    Sheep / goats:

    Pigs:

    Chickens:

    Hay-baling equipment

    Tractor:

    Lawn Mower: 

    Rototiller:

    Planting seeds or transplants:


    Caring for a garden:


    Planting or harvesting farm crops:


    Pruning trees:

    Making compost:

    Farmers market:

    Canning / preserving food:

    Cooking for others:

    Washing dishes:

    Computers:

*Experience in these areas is NOT required for acceptance into the program.  

What kinds of things do you like to do in your spare time?

Do you follow a special diet?

What would you like to learn while you're here?


What books have you read about farming or gardening?


Please use the space below to tell me anything you'd like me to know about 
yourself -- past, present and / or future.


List references, names, addresses and phone numbers, please.  I will attempt 
to call the people you name here.  Keep in mind that I would like to know 
what kind of a person you are to live with and work with.  Please list from 1 
to 4 people.


    You must have a tetanus vaccination in order to work at the farm.  Check 
with your doctor to see if yours is current.  If not, you'll need to have one 
before you come.  Please mail or bring documentation with you.  The 
vaccination is not very expensive.


Signature _________________________________ Date___________________________
    

    Thank you!  for taking time to answer this questionnaire.  I'll either 
call you or send you a response by mail or email.  If you don't hear from me, 
feel free to give me a call at (814) 364-9171 fax or email CommonGro@aol.com.

    Send this back to: Leslie Zuck, Common Ground Organic Farm, 176 Zuck 
Road, Spring Mills, PA  16875.  You may fax your application to (814) 
364-2330 or email to CommonGro@aol.com.