WASHINGTON TILTH PLACEMENT SERVICE APPRENTICESHIP PROGRAM

FARM APPLICATION FORM

Submit this form to request an intern(s) for your farm to:

TILTH PLACEMENT SERVICE

P.O . BOX 85056

SEATTLE, WA 98145-1056

FARM NAME	DATE
CONTACT PERSON	DAY PHONE
STREET ADDRESS	NIGHT PHONE
CITY, STATE, ZIP, COUNTY	FAX and/or E-MAIL

SUMMARY OF CROPS AND OPERATIONS (Please check all that apply):

c Tree Fruits c Berries c Vegetables c Seeds c Grains/Hay

c Herbs c Flowers/bulbs c Nursery c Dairy c Livestock

c Other ________________________________________________________

PROGRAM INTEREST

· Number of Apprentices Needed: _________ c Couples OK

· Length of Stay (approximate dates): Start _____________ Finish _____________

APPRENTICE QUALIFICATIONS

· Farming Experience: c Not Necessary c Helpful c Preferred

· Specific Skills or Knowledge (if any):
___________________________________________________________________

WORK ENVIRONMENT

· Brief Description of Type of Work:
_____________________________________________________________________

· Work Hours: c Full Time c Part-Time c Negotiable

· Learning Opportunities: c On the Job c Set-aside Time c Self-determined

COMPENSATION/EXCHANGE

· Pay Arrangement c Yes c No

· Housing/Living Quarters Provided: c Yes c No c Maybe

· Meals Provided: c Share with Family c Separate Cooking c No

ADDITIONAL NOTES c Check here if attaching additional information on separate sheet.