Applicant information
First name
Last name
Street address line 1
Street address line 2
City
State
Zip code
Telephone
Email
Household
Number of adults in household
Number of children in household
Income eligibility
Yes, my family income is at or below the above listed guidelines and we are requesting a CSA Scholarship.
Scholarship amount
I am requesting (up to $400) from the Sauvie Island Organics Scholarship Fund.
Recipient responsibilities
If granted a scholarship I agree to pay my portion of the share by making scheduled payments throughout the season.
Form action
