Agrivoltaics Education and Training Institute Application Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Food Allergies/ Dietary Restrictions (if none, put N/A) Regular Fee: $1600 To receive a discounted fee check all that apply (discounts can be 100% depending on need and qualification) I live/farm in Bullock County I work for or with an Ag Extension I am an agriculture instructor I teach agriculture or electrical engineering at tech education center I teach at a Community College/ University I am an agriculture, electrical engineering, or environmental engineering student I am a presenter at the institute I work with a community organization I work with a community farmers market I plan to volunteer at Little USA in Union Springs I plan to volunteer at Little USA in Union Springs Will you be able to commit to attending both the 2-day Hands-On Solar training, as well as the 2-day Agrivoltaic Learning session in Union Springs, Alabama? * Yes No How did you learn about LUSA's Introduction to Green Energy & Agrivoltaic Workshop? * If you are a qualified individual with a disability or identify as a disabled veteran, you may request a reasonable accommodation here (if not applicable, please put N/A) * Do you have internet access (Broadband, Wifi, Internet)? Yes No Prior to the 1st day of the workshop, will you be able to complete the required online course? Yes No Prior to the 1st day of the workshop, will you be able to read required chapters form the textbook provided? Yes No What interests you the most about LUSA's Green Energy: Agrivoltaic course? * Can you recommend anyone for this upcoming workshop? If so, please provide the name and email of the person: FOR WORKSHOP APPLICANT ONLY * By printing your name in the box below this certifies that the above information is correct. Thank you!
