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* 1. Participation Requirements: to participate in 2018, a market must have all of the following. (please check what your market has)

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* 2. Name of market:

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* 3. Market manager name, address (street, town, zip), email, and cell phone number:

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* 4. Market SNAP & Maine Harvest Bucks point person, if different from above - name, address (street, town, zip), email, and cell phone number. (This person will be the primary point of contact for MFFM regarding program updates throughout the season):

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* 5. Name of the person completing this application:

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* 6. Market mailing address (street, town, zip):

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* 7. Market physical address (street, town, zip):

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* 8. Market start date:____________

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* 9. Market end date:____________

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* 10. Market day(s) & start/end times:

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* 11. Market FNS number:____________

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* 12. When did the market obtain its FNS number, and in whose name?

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* 13. Number of vendors with SNAP-eligible foods:____________

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* 14. Number of produce vendors:____________

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* 15. Does the market accept credit/debit cards?

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* 16. How long has the market accepted EBT?

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* 17. What company does the market use for its EBT point of sale service?

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* 18. Has the market ever offered an incentive program before Maine Harvest Bucks? If yes, please describe the program, including what was incentivized, how it was funded, and for how many years the program was offered.

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* 19. Who will run the program at the market? Please describe the market’s plan, including job descriptions outlining roles and responsibilities (how will the market’s EBT point person, the market manager, the market treasurer, and others divide the relevant tasks, such as reimbursements to vendors?).

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* 20. How do you plan to promote the SNAP and MHB program at the market? Please describe the market’s plan, including at least 3 outreach methods. The more detail you provide the better, such as timeline, budget, audience, etc.

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* 21. Every dollar the market accepts in FINI funds needs to be matched with private donations either cash or in-kind. The private donations will include volunteer time, but should also include other fundraising avenues (such as asking credit/debit shoppers to “round up” their purchases, soliciting sponsorships from area business, developing a social media fundraiser, etc.). Please provide an estimate of how much volunteer investment and how much fundraising your market can expect in the 2018 season:

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* 22. MFFM has recently submitted grants to help fund MHB for years to come, however, the earliest grant funding would arrive is in late June. What is your market’s plan for fundraising and operating MHB from April 1 through the end of June (expected funding gap period)? How would your market handle the circumstances if MFFM is unsuccessful in our current grant pursuits and cannot provide financial support for MHB this year?

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* 23. What local entities/organizations actively support and/or work with your market in some capacity? (Examples include health clinics, Chambers of Commerce, SNAP-Ed, local nonprofits, etc.)

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* 24. Why do you feel SNAP access at your market is important in your community/region?

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