Community CROPS

Financial Assistance Application for Community Garden Plot

Our goal is to increase access to fresh, nutritious food for all members of our community. We are committed to making our Community Garden program accessible to individuals and families of all economic backgrounds. To make this possible, we offer Financial Assistance to help cover part or all of the cost of a garden plot. Financial Assistance is available to those meeting our income guidelines.

*Name:
*Address:
*Phone:
*Email:
*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	$1,174.00
2	$1,579.00
3	$1,984.00
4	$2,389.00
5	$2,794.00
6	$3,200.00
7	$3,605.00
8	$4,010.00
Additional members	Add $406.00

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