Agricultural Innovation Program Entrance Assessment Form
Assess your background, readiness, and proposed agricultural innovation for entry into the program. Please complete all sections accurately.
Applicant Profile
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Organization or Farm Name
*
Role / Title
Program Readiness Assessment
Applicant Type / Primary Background
*
Farmer
Agribusiness Founder
Researcher
Student
Extension Worker
Cooperative Leader
Other
Current Readiness to Participate
*
Not Ready
1
2
3
4
5
6
7
8
9
Fully Ready
10
1 is Not Ready, 10 is Fully Ready
Years of Relevant Experience
Innovation Proposal Evaluation
Proposed Innovation or Project Idea
*
Main Agricultural Problem Addressed
*
Target Beneficiaries or Users
*
Priority Assessment
*
High impact
Moderate impact
Low impact
Highly scalable
Moderately scalable
Limited scalability
Resources and Support Needs
Resource Availability and Constraints
*
Rows
Available
Limited
Not Available
Land access
1
2
3
Equipment access
4
5
6
Technical support
7
8
9
Funding need
10
11
12
Internet access
13
14
15
Device access
16
17
18
Land Access Status
*
Please Select
Available
Limited
Not Available
Technical Support Needed
Please Select
No additional support
Mentorship
Training
Extension services
Funding guidance
Equipment access
Other
Additional Comments or Support Needs
Submit Assessment
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