Opportunity Gardens Application 2023

Thank you for your interest in Opportunity Gardens!

The following application will determine your eligibility, based on:

You are committed to being in the three-year program
Your address is in Columbia, Missouri
Your household meets the income requirements for Free/Reduced Lunch
If you rent, your landlord will allow a garden

It will also collect information about your household, household's special needs and goals, languages spoken, and other services you use to help us better support you and your family. Everyone is welcome to apply, but priority is given to households with children aged 19 and younger.

If you have any questions about the application or would like a paper application mailed to you please call or text us 573-529-2756.

We look forward to the opportunity to garden with you!

Household Eligibility:

Question Title

* 1. Please provide your contact information

Your Name *

Address (where your garden will be installed) *

Apartment (optional)

City *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Please provide a back up Phone Number
(Please include area code. Example: 573-555-5555)

Question Title

* 3. Do you live in Columbia Public Housing?

Yes

Question Title

* 4. Do you rent or own your home?

Rent

Own

Question Title

* 5. Annual Gross Household Income
(This is income BEFORE taxes and deductions are taken out.)

Question Title

* 6. Monthly Gross Household Income
(This is income BEFORE taxes and deductions are taken out.)

Question Title

* 7. How many people are in your household?

Question Title

* 8. Do you or anyone in your family qualify for the following?
(Please select all that apply)

WIC (Supplemental Nutrition Program for Women, Infants, and Children)

Free/Reduced Lunch

EBT/SNAP (formerly known as Food Stamps)

Medicaid

Medicare

Disability

Social Security

I don't know

I don't qualify for any of these programs

Household Information:

In this section, please list the name and information for every person that lives or eats regularly at your house.

This information helps us to better support you, as well as request funding from other organizations and grants to continue the program. The information is kept confidential, and only reported outside of CCUA in aggregate (without your name/contact info).

Question Title

* 9. What is your name?

Question Title

* 10. What is your Race?
(Please check all that apply)

Native American Indian or Alaskan Native

Asian or Asian American

Black or African American

Middle Eastern

Native Hawaiian or other Pacific Islander

White or Caucasian

Multiple Races

Another race

Question Title

* 11. Do you identify as Hispanic or Latino?

Yes

Question Title

* 12. What is your Age?

Question Title

* 13. What is your Gender?

Question Title

* 14. I currently:

Live in the house and eat at the house

Visit the house and eat at the house

Question Title

* 15. Are there more people who live or eat regularly at your house?

Yes

Opportunity Gardens Application 2023

Question Title

* 1. Please provide your contact information

Question Title

* 2. Please provide a back up Phone Number (Please include area code. Example: 573-555-5555)

Question Title

* 3. Do you live in Columbia Public Housing?

Question Title

* 4. Do you rent or own your home?

Question Title

* 5. Annual Gross Household Income (This is income BEFORE taxes and deductions are taken out.)

Question Title

* 6. Monthly Gross Household Income (This is income BEFORE taxes and deductions are taken out.)

Question Title

* 7. How many people are in your household?

Question Title

* 8. Do you or anyone in your family qualify for the following?(Please select all that apply)

Question Title

* 9. What is your name?

Question Title

* 10. What is your Race? (Please check all that apply)

Question Title

* 11. Do you identify as Hispanic or Latino?

Question Title

* 12. What is your Age?

Question Title

* 13. What is your Gender?

Question Title

* 14. I currently:

Question Title

* 15. Are there more people who live or eat regularly at your house?

* 2. Please provide a back up Phone Number
(Please include area code. Example: 573-555-5555)

* 5. Annual Gross Household Income
(This is income BEFORE taxes and deductions are taken out.)

* 6. Monthly Gross Household Income
(This is income BEFORE taxes and deductions are taken out.)

* 8. Do you or anyone in your family qualify for the following?
(Please select all that apply)

* 10. What is your Race?
(Please check all that apply)