Check the UFFBM role(s) you/your team are applying to manage and maintain from 2021 - January 2022 (check all that apply). *CLICK GREEN BUTTON AT TOP OF THIS WEBPAGE TO REVIEW DECRIPTIONS OF ROLES ETC.
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(*) =This position may become elevated to go across all City of Atlanta Urban Agriculture programs and activities.
Applicant Name
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Contact Information: Manager (Team Leader)
First Name
Last Name
Phone
(###)
###
####
Email
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501 (c) 3 Status/Tax ID
Year Established
Name : Organization Lead
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Organization lead authorized to enter partnership agreement
First Name
Last Name
Name: Organizational Contact
(Contact City will work with throughout 2021 Partnership Agreement)
First Name
Last Name
Phone
(###)
###
####
Email
Check each box below to confirm: (Applicants that meet 100% of the threshold requirements will proceed to the application review process)
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1) Why are you interested in becoming a UFFBM Partner Team?
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2) What experience(s) do you have to help you perform the Team Partner role you’re applying for? Please share dates or time frame the experience(s) happened.
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3) Have you participated in any educational/training programs that prepare you for the Team Partner role you are applying for? If yes, please explain.
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4) Do you have any certifications, awards, qualifications, etc. in the Team Partner role you are applying for? Are you currently pursuing any? If yes, please explain.
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5) Please submit any additional materials demonstrating your experience, skills, and qualifications below or email to AgLanta@AtlantaGA.GOV
1) Do you/your organization live, work, or own a business within zip codes 30315, 30354,30304 and/or NPU Y or Z?
Yes
No
If yes, please share zip code and/or NPU
If yes, please share experience location and date:
3) Does your leadership team include? (please check all that apply)
If yes to any above, please explain here:
4) Does your organization include? (please check all that apply)
If yes to any above, please explain here:
5) Do you/ your organization have experience maintaining and managing portions of the UFFBM site currently?
Yes
No
If yes, please explain:
SUMMARY OF APPLICATION FEES: Your team understands it is is responsible for raising any funds needed for your proposal.
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Yes
No
TEAM SIGNATURE # 1
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Typing this name in means this team member has signed off on this form.
First Name
Last Name
TEAM SIGNATURE # 2
Typing this name means this team member has signed off on 100% of the contents of this form.
First Name
Last Name
Date
Date Team Members signed and submit this application.
MM
DD
YYYY
