KDD CSA Pilot

Kentucky Double Dollars CSA Interest Form
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
You must be a current SNAP user to qualify for this program. Are you currently receiving SNAP benefits? *

Yes No Unsure
Have you ever participated in a CSA program? *

Yes, I have participated in a CSA program in the past. No, I am brand new to CSA programs. Unsure
Have you ever participated in Kentucky Double Dollars? *

Yes No Unsure
What is your preferred partner farm and pickup day? *
What is your preferred way of communicating about this CSA share? (Select all that apply.) *

Text Phone Email Other
What factors are motivating you to participate in this program? *

Wanting access to better quality food Wanting to use my SNAP benefits on CSA Wanting to try out a CSA for the first time Wanting to support local farms and farmers Wanting to help my family eat better Wanting to learn more about how my food is produced Wanting access to more organic foods Other
How did you hear about this program? *
Do you have any questions for us?
Should be Empty:

Kentucky Double Dollars CSA Interest Form