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Financial Assistance Application for Growing Farmers Winter Workshop Series

Scholarship Application Due: January 16, 2012

A limited number of need-­based scholarships to help cover workshop fees are available to those showing financial need. The workshops are $300 for the series or $40 each, individually. Scholarship recipients pay $10 per workshop.

Need-­based transportation and childcare scholarships are available to women who show financial need. Transportation scholarships are $10/workshop. Childcare scholarships are $25 for 1 child and $15 for each additional child per workshop. Required fields are marked with an *.

Mark ALL that apply:
I am applying for a scholarship to help pay workshop fees.
I am applying for a scholarship to pay for childcare (women only).
I am applying for a scholarship to pay for transportation (women only).
*Name:
*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 January 18 and arrange a payment plan with you for your remaining fees at that time. Childcare and transportation scholarship funds will be distributed at the end of each workshop.

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.