CROPS CSA Scholarship Application

CROPS CSA Financial Assistance Application

Scholarship Application Due: April 1, 2012

Need-based scholarships to help pay for one CSA share through our "Share-a-Share" program are available to those with financial need. One share is $300 for the 20 week season. Scholarships cover up to $250. Scholarship availability is determined by community donations each year. The remainder of your payment can be made in cash, or weekly via EBT at the pick up.

Share-a Share boxes will have 4-5 different vegetables in them each week, which changes throughout the season. For example, a spring bag might have carrots, lettuce, snow peas and radishes, a summer bag might have potatoes, tomatoes, onions and bell peppers, and a fall box might have butternut squash, beets, watermelon and sweet potatoes. The CSA will begin on May 24 and go for 20 weeks (plus a week off in June and August), through October 25.

You must fill out the full CSA application in addition to this form to be eligible for a CSA scholarship.

Required fields are marked with an *.

*Name:
*E-mail:
*Job:
Spouse's Job:
*Monthly Income:
Add'l Income (child support, etc.)::
Number of children supported by the individual/family:
*Monthly Expenses:
*Combined adjusted gross income from IRS Federal Tax Form:

Eligibility categories

Select one category of eligibility below and complete. We require proof of current income mailed to us.

Individual/family receives public assistance

Mark those that apply:

Social Security Unemployment Disability AFDC Medicaid Food Stamps/EBT WIC

Income for entire household is under:
Household Size	Gross Monthly Income
1	$1,180.00
2	$1,594.00
3	$2,007.00
4	$2,421.00
5	$2,385.00
6	$3,249.00
7	$3,663.00
8	$4,077.00
Additional members	Add $414.00

Individual/family income is over guidelines, but feel assistance is needed.
Please explain:

We will notify you of your scholarship amount by April 10 and arrange a payment plan with you for your remaining costs at that time.

Please submit your proof of income by e-mail to barb@communitycrops.org or send it to Community CROPS at 1551 S. 2nd Street, 68502.