Cape Cod’s Trees for Tomorrow – Restoration Kit Application Form

Cape Cod’s Trees for Tomorrow – Restoration Kit Application Form
Please fill out this form to determine eligibility for a free or low-cost restoration kit. Your information will remain confidential and is only visible to the board of directors or designated committee members. Required fields are marked with an asterisk ().*

*This is an encrypted form*
Section 1: Contact & Address

We need your contact information to verify your address, communicate about your application, and deliver your kit if you are approved. Your contact details are kept confidential and will not be shared or sold.
Name*

First NameLast Name
Phone Number
Email*
example@example.com
Gender*

MaleFemalePrefer not to sayOther
Zip code *
Do you reside in a high-risk area for tree loss or environmental degradation?*

YesNoUnsure
Section 2: Finical Access

Why we ask this: This helps us identify applicants who may face financial barriers to participating in environmental restoration programs, ensuring fair and equitable access.
Is your household income below $75,000 per year?*

YesNoPrefer not to say
Do you currently receive any financial assistance (e.g., SNAP, disability, housing support)?*

YesNoPrefer not to say
Would the cost of a restoration kit (~$25) be a barrier for you?**

YesNoPrefer not to say
Section 3: Access Barriers & Equity

Why we ask this: We aim to ensure that our program is accessible to people who may face social, systemic, or other barriers. Your responses help us reach underserved communities and improve equity, but they are optional.
Do you have a disability or physical limitation?*

YesNoPrefer not to say
Is English your primary language?*

YesOther
Do you identify with any underrepresented racial or ethnic group? Check all that apply*

WhiteBlack or African AmericanHispanic / LatinoAsianNative American / Alaskan NativeNative Hawaiian / Other Pacific IslanderPrefer not to sayOther
If there are any other barriers or circumstances that may make it harder for you to access community environmental programs, please explain
Section 4: Additional Information

Why we ask this: This helps us understand the unique ways our kits could benefit your household or community and ensures that we are supporting people in meaningful ways.
Why would receiving this kit help you or your community?
Section 5: Consent, Privacy & Terms

Why we ask this: It is important that applicants understand how their data will be collected, stored, and used. Consent ensures you are informed and agree to these terms before submitting your application.
Consent & Privacy Agreement*
By submitting this form, I acknowledge and agree to the following:

Confidentiality: My information will be stored securely and accessed only by Cape Cod’s Trees for Tomorrow board members or designated committee members.

Use of Data: My responses will be used solely to determine eligibility, ensure fair access, and improve our restoration programs.

Data Security: Cape Cod’s Trees for Tomorrow uses reasonable security measures to protect my information, but no system is completely immune to breaches. I release the organization from liability in the unlikely event of unauthorized access beyond its control.

Honesty Standard: I certify that all information I provide is truthful and accurate. Providing false or misleading information may disqualify my application.

Eligibility Discretion: Eligibility is determined holistically based on all responses. Submission of this form does not guarantee receipt of a free or low-cost kit.

Voluntary Participation: Providing demographic or optional information (disability, language, race/ethnicity, personal statement) is voluntary. Choosing not to answer may limit the board’s ability to fully understand your circumstances, which could influence eligibility decisions. Your choice to answer or not will be respected, and applicants will not be penalized for skipping optional questions, but incomplete information may affect the board’s holistic review.

Data Retention: Personal information and application responses will be securely retained for program verification, accountability, and reference purposes. Access will be limited to Cape Cod’s Trees for Tomorrow board members or designated committee members. Data will not be shared or sold outside the organization and will be kept as long as necessary to maintain accurate records of program participation and equity tracking.

Contact & Follow-Up: By submitting this form, I consent to be contacted by Cape Cod’s Trees for Tomorrow regarding this application and other marketing emails.
I have read, understood, and agree to these terms.*
Terms & Conditions*
Your eligibility for a free or low-cost restoration kit will be determined based on the responses you provide in this application. The board or designated committee will review your answers holistically, taking into account location, financial access, access barriers, and other relevant factors. Applicants are expected to provide honest and accurate information. Providing complete and truthful responses helps us ensure fair and equitable access for everyone.
Applicant's Signature*

Clear
Date Signed*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Cape Cod’s Trees for Tomorrow – Restoration Kit Application Form

Section 1: Contact & Address

Section 2: Finical Access

Section 3: Access Barriers & Equity

Section 4: Additional Information

Section 5: Consent, Privacy & Terms