Common Ground Client Intake form

Common Ground Collective

New Client Intake Form
Thank you for your interest in becoming a CGC client! Please take a moment to fill out this form completely so we can get to know you better and have an idea of how we can best support you with our services. If a question does not apply indicate N/A.
Once submitted a representative will contact you within 5 business days to discuss the next steps.

Thank you and we look forward to growing with you!
Applicant's Name*

First NameLast Name
Business Name
Organization Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
What services are you interested in? Please check all that apply.
Mobile Farming Services

InstallationMaintenanceHarvestingEmergency Farm HelpUnsureOther
Administrative Services

County ComplianceData Collection and ManagementResearchMarket ConnectionsLand Design & Crop selectionBusiness DevelopmentUnsureOther
Education

InternshipsEducational WorkshopsVolunteer OpportunitiesCommunity EngagementOrganizational and Business PartnershipsUnsureOther
Client Demographics
Ethnicity

CaucasianNative HawaiianPacific IslanderAsian AmericanHispanicAfrican AmericanNative AmericanTwo or more racesUnsureDecline to answerOther
Household Size
Household Income (Answer if you'd like to be considered for sliding scale payment.)

Less than $20,000$20,001 to $25,000$25,001 to $30,000$30,001 to $35,000$35,001 to $40,000$40,001 to $45,000$45,001 to $50,000$50, 001 to $55,000$55,001 to $60,000$60,001 to $70,000$70,001 to $80,000$80,001 to $90,000$90,001 to $100,000$100,001 to $110,000$110,001 to $130,000$130,001 to $160,000
Property Location

North MauiUpcountrySouth MauiCentral MauiEast MauiWest MauiUnsureOther
Property Size

Less than 1/2 Acre1/2 acre to 1 acre1-2 acres3-4 acres5+ acresOther
Is the property currently in production?

YesNoProducing but not managedUnsure
How did you hear about us?(Referrals or articles check other and type in name of business, person or publication.)

WebsiteFacebookInstagramHFUUKohala CenterWeb SearchOther
Any other questions or concerns?
Should be Empty:

Common Ground Collective