Backyard Vegetable Garden Application Form

GARDEN
A
T
C
I
I
O
L
N
P
P
A
Green Light Garden Program Requirements
1. Own your home or have landlord permission
CALL AND SIGN UP TODAY, IT’S EASY!
2. Provide an outdoor space that meets these
qualifications:
• Minimum of 6 hours sunlight daily
• Source of water near the garden bed
• Location of garden bed needs to be on soil
& allow for digging 6” down into the soil
3. Pledge to grow only edible food & to maintain
(water, weed, plant, & harvest) your garden for
at least 5 years
4. Pledge to compost food scraps & yard waste to
recycle soil nutrients so that you will have compost to
add to your garden each planting season
5. Attend 2-hour “Organic Gardening 101” class
6. Participate in surveys to track program impact
7. Allow Green Light to conduct seasonal check-ins and
to list your garden's location on maps of where
gardens have been installed—our long-term goal is to
help nurture a robust gardening community where
Green Light gardeners share knowledge, assistance,
tools and seeds.
BROUGHT TO YOU BY GREEN LIGHT NEW ORLEANS
!
BACKYARD GARDEN PROGRAM APPLICATION
To apply, please answer all of the following questions. The purpose of this form is to
determine if your household qualifies for this program and to establish mutual expectations
(what you can expect from us and what we require from you as a participant).
First Name:___________________________
Last Name: _____________________________
Street Address:___________________________________
City: ________________________________State: _______________ Postal Code:_______
Phone(s):______________________Email:___________________________________________
If you have an email address, please include it—we often utilize this mode of contact to get in
touch with our gardeners!
1a. Do you rent or own your home?
Rent
Own
(If renting, you must have written permission from your landlord)
DOWNLOAD LANDLORD PERMISSION FORM
Contact Information For Landlord:
First Name:__________________________
Phone:
Last Name:_________________________-
1b. Are you currently growing vegetables in your yard?
Yes
No
If YES, STOP. Contact our garden manager at [email protected] to participate in
our Experienced Growers Program!
2.
How many years have you lived at your current address?
3.
How long do you plan to live at your current address?
4.
How many adults (18+), including yourself, live in your household?
5.
How many children below age 18 are in your household?
aged 0-5yrs
aged 6-12 yrs
aged 13-17 yrs
_________________________
N/A
Green Light New Orleans - - 8203 Jeannette St - - NO, LA 70118 - - 504-324-2429
6.
If you have children, what school(s) are they enrolled in?
7.
If you have children, do they participate in garden education programs at school?
☐ Yes ☐ No
8.
Do you have outdoor space at your home/apartment that receives at least 6 hours of
sunlight daily and will accommodate a garden bed that measures 4 ft by 4 ft square
(8 inches tall)?
Yes
No
9.
Are you willing to let volunteers dig 6 inches into your yard in a 4ft by 4ft square?
Yes
No
10. Is there a source of water near your planned garden space?
None
No
☐Yes
Some
A lot
11.
How much experience do you have growing food?
12.
Are you willing to grow ONLY edible plants (vegetables, fruit, and herbs) in the garden bed?
☐ Yes
No
13.
Are willing to compost your food scraps and yard waste to build soil for your garden bed?
☐ Yes
☐ No
14a. Are you prepared to devote regular time, year-round to caring for your garden? (we
provide follow up support throughout the season, but gardening will be your responsibility)
☐ Yes
☐ No
14b. Are you prepared to provide daily garden care and maintenance for your garden bed
including but not limited to: weeding, harvesting, watering, replanting?
Yes
No
15.
What level gardening class would you require?
Beginning
Intermediate
Advanced/Expert
Green Light New Orleans - - 8203 Jeannette St - - NO, LA 70118 - - 504-324-2429
16.
We require that you attend a two-hour Gardening 101 class to help you get started. What
days and times work best for you? Check all that apply
MON am
MON pm
17.
TUES am
TUES pm
WED am
WED pm
THURS am
THURS pm
FRI am
FRI pm
SAT am
SAT pm
Which days/times are you available for your garden installation? Check all that apply.
MON am
MON pm
TUES am
TUES pm
WED am
WED pm
THURS am
THURS pm
FRI am
FRI pm
SAT am
SAT pm
18. Will you complete a short survey in the spring, summer, and fall to help gather data
that will make it possible for Green Light to continue this program for others in the future?
☐ Yes
19.
No
a) Will you allow Green Light staff to conduct seasonal check-ins?
Yes
No
b) Will you allow Green Light to list your garden’s location on maps of where gardens
have been installed? (your name and personal information will not be shared)
Yes
No
20.
How did you hear about Green Light’s Backyard Garden program?
21.
Why would you like to become a backyard vegetable gardener?
22. Do you have any family members or close friends who grow their own food or are regular
gardeners?
Yes
No
23.
Please check if you have participated in the following Green Light programs
Energy-efficient light bulb program Program:
Rain barrel program:
Green Light New Orleans - - 8203 Jeannette St - - NO, LA 70118 - - 504-324-2429
24.
Would you like Green Light to refer you to the New Orleans Fire Dept to receive free
smoke detectors?
Yes
No
25. Would you like Green Light New Orleans to share your personal information with our
partner organizations to bring you additional opportunities?
Yes
No
MATERIALS
26. Are you a Green Light member?
Yes
No
27. We ask you to share the cost of your garden:
Please take some time to evaluate your financial resources
based on the suggested levels of our sliding scale, and
consider what level of contribution will be appropriate for
your household. We believe that financial security doesn’t
depend solely on income level, therefore we ask you to selfassess your financial security to determine your contribution
level. The required minimum contribution is $10.
I can make a contribution of $10.
I feel financially secure to make a contribution of $50.
I feel financially secure to make a contribution of $100.
I can cover the cost of all the materials $180.
I feel empowered by your work and can also provide the
materials for another family $360.
Cost
Raised Garden Bed
Composit
$31.50
Black Cow Manure
$5.58
Mushroom Compost
$4.66
Soil from Sugarland
$48.00
Fish Emulsion
$9.28
$12.00
Seedlings
Seeds
$3.00
Landscape Fabric
$4.00
Compost
$5.00
Pine Needles
$2.00
Paint
$10.00
Artist
$35.00
Garden Class
$10.00
SUBTOTAL MATERIALS
$180.02
I certify that the above information is true and correct.
______________________________________________________________________________
Signature
Date
When your application is complete, please send it via mail or email to:
Garden Program Coordinator
Green Light New Orleans
8203 Jeanette St
New Orleans LA 70118
[email protected]
Questions? Contact us at: (504) 324-2429
Green Light New Orleans - - 8203 Jeannette St - - NO, LA 70118 - - 504-324-2429