Forestry Management and Land Retention Project
Please Do not use ALL UPPER CASE. For Full Name type your first name then last name.
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Full Name:
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Mailing Address:
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City:
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Zip:
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Home Phone Number:
Cell Phone Number:
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Email Address:
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Race:
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
Other
Declined
American Indian/Alaska Native
Unavailable/Unknown
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REC Member:
Yes
No
If REC Member, provide Account No:
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County where the property is located:
Halifax
Northampton
Bertie
Gates
Hertford
Other (Specify below)
If County is Other, provide County:
Physical Address of property: (must be street, road, highway - No PO Boxes)
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Physical Address:
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Do you own 10 or more acres of land? :
Yes
No
Which of the following statements is true regarding your land? (You may select more than one answer.)
My land is jointly owned by others and is considered heirs property.
My land has clear title.
I own land but I'm not sure about its status.
I have trees on my land.
If there are trees, estimate how many acres of trees or woods you have.
Acres of trees/woods:
I am farming my land.
My land is rented to a farmer.
My land has a forest management plan.
My land has a stewardship plan.
The trees on my land were cut in the last three years.
I am working with agencies to manage the trees on my land.
Have you worked with a Natural Resource Professional to plan or manage your land?
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Worked with a Resource Professional:
Yes
No
If you worked with a Resource Professional then select all that apply:
Cooperative Extension
State Forest Service
University
US Forest Service
Industry Forester
Consulting Forester
NC Wildlife Commission
US Fish-Wildlife
Other (Specify below)
Other Resource Professional:
Are you interested in attending a workshop at The Roanoke Center to learn more about how you can use your land to earn money?
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Interested in workshop:
Yes
No
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