ROCS GARDEN PROJECT + BEYOND APPLICATION
From harvesting and preserving this year's produce to preparing for fall planting and planning next year's garden, gardening is a year-round process. We're here to help!
Applicant Name (Head of Household)
*
First Name
Last Name
County of Residence
*
Citizenship:
*
Please Select
US Citizen
Naturalized Citizen
US National (Born in Amercan Samoa/Swain Islands)
Lawful permanent resident
Refugee
Asylee
Parolee
Conditional Entrant
Cuban/Haitian Entrant
Battered Immigrant/Children
Trafficking Victim (T Visa)
Afghan/Iraqi National
American Indian born in Canada
Federally Recognized Indian Tribe (born outside USA)
Individual covered under Compacts of Free Association (COFA)
Undocumented resident
Non-Eligible Legal Resident
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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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Please select which supplies you currently need to GROW:
Fruit Seeds
Vegetable Seeds
Herb Seeds
Flower Seeds
Soil
Seed Starting Trays
Gardening Tools
Weed Barrier or Netting
Please select which supplies you currently need to HARVEST:
Baskets / Crates
Shears / Pruner / Thumb Knife
Garden Gloves
Sprayer
Please select which supplies you currently need to PRESERVE:
Vinegar
Canning Tools
Brine Mixes
Mason Jars
Labels
Freezer Bags
Recipes / Instruction
Please select which supplies you currently need to PLAN:
Graph Paper
Garden Planner
Book About Growing Produce
Planting Calendar
Measuring Tape
Seed Storage Envelopes
Plant Markers
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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