ROCS GARDEN PROJECT APPLICATION
The ROCS Garden Project provides herb, fruit, and vegetable seeds to qualified households and community gardens, as well as educational workshops and resources to assist along the way. Households that do not income qualify may still have access to ROCS Garden Project educational resources and support community.
Applicant Name (Head of Household)
*
First Name
Last Name
County of Residence
*
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Housing Type:
*
Please Select
Own
Rent
Public Housing
Other Permanent Housing
Homeless
Temporarily living with friends/family
Other
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HOUSEHOLD INFORMATION
Please complete the fields below, starting with the Applicant/Head of Household. You must list every individual residing in the household, including children.
Head of Household / Household Member #1
*
Household Member #2
Household Member #3
Household Member #4
Household Member #5
Household Member #6
Household Member #7
Household Member #8
*I have additional household members to add to my application:
Yes
No
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HOUSEHOLD INCOME INFORMATION
To qualify for services, you must complete this page and provide income verification.
Select all types of income you've received in the past 12 months.
*
Employment
SSI/SSDI
Child Support
Self-Employment
Interest
Pension
Unemployment
TANF/SNAP
General Assistance
LIHEAP
Other
NONE
TOTAL ANNUAL INCOME FROM ALL SOURCES:
*
PLEASE UPLOAD INCOME DOCUMENTATION HERE:
*
Browse Files
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Tax Return, Paystubs, SSI/SSDI Statement, SNAP, etc.
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Do you have any produce gardening experience?
*
Yes
No
How comfortable or confident are you in your gardening skills?
*
1. Beginner - I have little to no experience.
2. Novice - I have some experience, but still learning.
3. Intermediate - I feel confident and can handle most tasks.
4. Advanced - I have considerable experience and skills.
What do you plan to use as your primary gardening space?
*
I'm Unsure/Undecided
Containers (outside)
Containers (inside)
Garden Bed (Ground or Raised)
If using a garden bed, what is the estimated size of your plot(s)?
Please select the type of seeds you would like grow:
*
Beets
Broccoli
Bush Beans
Cantaloupe
Carrots
Cauliflower
Corn
Cucumber
Dill
Peas
Pumpkin
Radish
Squash
Swiss Chard
Watermelon
Zucchini
Do you have experience with canning produce?
*
Yes
No
Are you interested in additional food storage information or workshops? (canning, freezing, etc.)?
*
Yes
No
Terms & Conditions
I hereby declare that the information and documentation I provided is accurate and true to the best of my knowledge. I understand that, if approved, seeds or any other resources provided is for personal use only, not to be used for profit.
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