Registration First Name* Last Name * Email Address * Phone Date of Birth * National Identification Number * State of Origin * Select Abia Adamawa Akwa Ibom Anambra Bauchi Bayelsa Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu FCT Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nasarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto Taraba Yobe ZamfaraLocal Government AreaOf originState of Residence * Select Abia Adamawa Akwa Ibom Anambra Bauchi Bayelsa Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu FCT Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nasarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara Local Government Area Of residence Street Address City * Level of Agricultural Experience * Select None Beginner Intermediate Advanced Previous agricultural activities (if any) Land ownership if any (size and location) Preferred Farm Region * Select North East North West North Central South East South West South South Must either be your state of Origin or State of Residence Preferred Agricultural Commodity - North East * Yam Maize Fruits & Vegetables Cassava Sugarcane Ranching Preferred Agricultural Commodity - North West * Wheat Maize Fruits & Vegetables Groundnut Sugarcane Guinea corn Benniseed Potato Rice Ranching Preferred Agricultural Commodity - North Central * Yam Maize Sugarcane Vegetables & Fruits Potato Ranching Preferred Agricultural Commodity-South East * Maize Sugarcane Vegetables & Fruits Rice Cassava Cocoa Plantain Soya Beans Preferred Agricultural Commodity-South West * Maize Sugarcane Vegetables & Fruits Cassava Cocoa Plantain Rice Yam Snail Farming Poultry Fish Farming Preferred Agricultural Commodity -South South * Yam Fruits & Vegetables and Palm Oil Highest Level of Education * Select PHD MASTERS BSc/HND OND/Diploma NCE WAEC/NECO/GCE School Leaving Certificate None Disability status (if any) Occupation (current or previous) Account Number * Account Name * Bank Name * Select your bank Access Bank First Bank GTBank UBA Zenith Bank Fidelity Bank Union Bank Stanbic IBTC Ecobank FCMB Heritage Bank Keystone Bank Polaris Bank Sterling Bank Wema Bank Unity Bank Jaiz Bank Disbursement Information All funds will be disbursed directly to the bank account provided above. Please ensure the account details are correct. Disbursement Schedule: First disbursement: Within 14 days of approval Subsequent disbursements: Quarterly based on project milestones Important Notes: Funds must be used exclusively for approved agricultural purposes You will be required to submit periodic progress reports Misuse of funds may result in revocation of the grant All transactions will be recorded and monitored I acknowledge that I have read and understood the disbursement information above * Please upload means of identification * Choose File No file chosen Delete uploaded file Only the following are acceptable: Voter's Registration Card, International Passport, Driver's License or NIN Printout Consent * Yes, I confirm that the information provided above are correct and can be used for my eligibility assessment.