SECTION 1:



Applicant/Company: FORMTEXT ?????Applicant #: FORMTEXT ?????If you need additional space for answers, use the Additional Comments Section on Page 4 and/or add additional sheets as necessary.SECTION 1: General InformationNOP Rule §205.401Have you ever applied for certification or been certified in the past? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, which agency(ies) and what year(s) were you certified? FORMTEXT ?????If yes, what address was your operation located at? FORMTEXT ????? FORMCHECKBOX N/A same addressAre you currently certified and switching from another certifier? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, which agency are you certified by? FORMTEXT ?????If yes, submit a copy of the previous year’s inspection report, certification decision letter, and certificate.If yes, do you have any outstanding noncompliances? FORMCHECKBOX Yes FORMCHECKBOX NoHas certification ever been denied, suspended or revoked? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, attach a description of the circumstance and documentation.Are you applying for any additional certification this year? (If yes, check below) FORMCHECKBOX Maple Syrup FORMCHECKBOX Mushrooms FORMCHECKBOX Wild Crops FORMCHECKBOX Greenhouse & Seedlings/Transplants FORMCHECKBOX Beef FORMCHECKBOX Dairy Cows FORMCHECKBOX Dairy Goats FORMCHECKBOX Hogs FORMCHECKBOX Sheep FORMCHECKBOX Poultry FORMCHECKBOX Other: FORMTEXT ????? FORMCHECKBOX On-farm/Off-farm Processing/Handling (bagging, freezing, cleaning, bottling, etc.)Describe any on-farm processing you do: FORMTEXT ?????If you are applying for any additional certification(s), you may need to complete an additional Organic System Plan (OSP). Please call MCIA with questions, to request additional OSP’s, or download the form(s) online at .Have you managed all fields being requested for certification for 3 or more years? FORMCHECKBOX Yes FORMCHECKBOX NoIf no, submit a Prior Land Use Statement (PLUS), or an equivalent document, signed by the previous land manager stating the use and all inputs applied during the previous 3 years. If you cannot obtain a PLUS, then land eligibility will be determined based on the date when you took control of the land.INSPECTION INFORMATIONPreferred time for inspection: FORMTEXT ????? FORMCHECKBOX AM FORMCHECKBOX PMList the date of the FIRST planned harvest (e.g. annual seedlings, early crops, early sales, etc.)? FORMTEXT ?????NOTE: New producers must be inspected before harvest. Contact the MCIA office if crops are ready for harvest and you have not been inspected.MEMBER INFORMATIONMCIA is a member run organization and we invite you to become a member. The membership fee and non-member application fee are the same and there are no required duties. Benefits of MCIA membership include voting privileges to elect MCIA board directors, the right to serve on the Organic Committee, and a voice in the direction of the organization. You will also receive a copy of the MCIA Directory and 4 issues of The Seed Grower. Under USDA NOP regulations, MCIA cannot require membership as a condition of certification.Would you like to become a member of MCIA? FORMCHECKBOX Yes FORMCHECKBOX NoSECTION 2: Current Year Crop and Carryover Crop SummaryNOP Rule §205.201CURRENT YEAR CROP SUMMARYComplete this table for your current year's crops (including pasture). Use additional sheets if necessary. CropOrganicacresTransitional acresConventional acresExpected Yield?Example: Corn25200150 bu/ac? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ??????? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ??????? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ??????? FORMTEXT ?????? 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FORMTEXT ?????CARRYOVER CROP SUMMARY If you have organic carryover crops from a previous certification, you MUST maintain certification for your crops to remain eligible for an organic sale. Please contact MCIA for further information regarding switching plete this table for all previous year(s) organic crops you have in storage. Use additional sheets if necessary. FORMCHECKBOX I do not have any carryover crops.CropYearProducedForm (grain, silage, etc.)Quantity (bu, cwt, tons, bales, etc.)List on Organic Certificate? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX ? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX ? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX ? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX ? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX ? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX ? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX SECTION 3: Seed, Seed Treatments, Seedlings and Planting StockNOP Rule §205.204Seed and Seed TreatmentsNOP Rule requires the use of organically grown seeds, unless an equivalent organically produced variety is not commercially available. If using non-organic seeds, you must have records of your attempts to source organic seed. Synthetic seed treatments including fungicides and inoculants are prohibited unless included on the National List. Genetically engineered/modified (GMO) seeds and inoculants are prohibited in organic production. NOP Rule uses the phrase "excluded methods" to refer to GMO products. NOTE: A prohibited treatment may only be used if such treatment is a Federal or State phytosanitary requirement.Please list each lot of seed planted for organic production, including cover crops. Keep a copy of each label/tag and receipts for each seed lot (seed tags, inoculant labels, and/or treatment labels). (Use additional sheets if necessary.)Will you plant all organic seed this year? FORMCHECKBOX Yes FORMCHECKBOX NoIf not, complete an Organic Seed and Planting Stock Search Record or similar record. Be certain to explain reason (justification) you require the non-organic variety. Kind/Variety/BrandLot No.Check if seed is OrganicTreatments/InoculantsSeek MCIA approval prior to usefor inspector use onlytagreceiptossut verificationnon-gmo statementqty purchasedqty plantedqty saved FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ?????Was any of the seed listed purchased in a previous year? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, list here along with the year purchased: FORMTEXT ?????Was any of the seed listed produced on your farm? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, list here along with the year produced: FORMTEXT ?????Purchased Annual Seedlings FORMCHECKBOX Not applicable – Go to Section CCertified operations must use organic seed, annual seedlings, and planting stock. Annual seedlings must be produced according to organic standards. NOTE: Nonorganically produced annual seedlings may be used to produce an organic crop when a temporary variance has been granted in accordance with NOP Rule §205.290(a)(2).ANNUAL SEEDLINGS (Use additional sheets if necessary)CropSeedling Source & CertifierInspector use onlyreceiptQuantityOG Cert FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????If Annual Seedlings or Transplants are grown on farm, please complete the Organic System Plan Supplement - Greenhouse and Seedlings.Please have documentation available for inspection that shows the source(s), quantity, variety(ies) and organic status of annual seedlings used. Purchased Planting Stock FORMCHECKBOX Not applicable Certified operations must use organic seed, annual seedlings, and planting stock. Use of non-organic planting stock is subject to commercial availability. If planting stock is from a non-organic source and is used to produce perennial crops, then that planting stock may be sold, labeled or represented as organic planting stock after 12 months of organic management. PLANTING STOCK (Use additional sheets if necessary)CropPlanting Stock Source& CertifierCheck if organicCheck if stock was bare rootIf non-organic, date plantedIf non-organic, expected harvest date FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ?????If Planting Stock is produced on farm, please complete the Organic System Plan Supplement - Greenhouse and Seedlings.Please have documentation available for inspection that shows the source(s), quantity, variety(ies) and organic status of planting stock used. If non-organic planting stock is used, maintain documentation of your search for equivalent varieties of organic planting stock and reasons for commercial non-availability (quantity, quality or form). Additional Comments: Add any additional comments or complete your answers from above (if you did not have enough room). FORMTEXT ????? ................
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