Community Agency Garden Application Question Title * 1. Contact Name First Name Last Name Question Title * 2. Contact E-mail Question Title * 3. Contact Phone Number Question Title * 4. Address of the Garden Street Address Street Address 2 City State/Province Postal/Zip Code Question Title * 5. How many people will be affected by this garden Question Title * 6. How many low income or at risk individuals will be served by this garden (at risk individuals are youth under age 18, retired people over the age of 65, and individuals with physical, emotional or mental needs) Question Title * 7. How will your garden increase access to fresh food and produce Question Title * 8. How will your garden raise awareness to the benefit of local food production Question Title * 9. How will your garden increase self sustainability in daily food habits Question Title * 10. I CERTIFY THAT ALL INFORMATION STATED IN THIS APPLICATION IS TRUE ANDCOMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE GROW FOOD GROW HOPE TO VERIFY THE INFORMATION PROVIDED.PLEASE VERIFY THIS APPLICATION BY TYPING YOUR NAME BELOW. 100% of survey complete. Done
