THE COMMUNITY FOOD ADVOCATES FIELD OF GREENS FUND APPLICATION FOR GRANT FUNDING FALL 2011 Please read

the Application Guidelines (a separate document) and then fill in the details below. Please be thorough but concise in your responses to the questions. The Field of Greens Fund and Community Food Advocates will only use this information for processing applications and verifying eligibility. Field of Greens will not share this information with any other individuals or organizations without your permission. If you have questions or need additional information please contact the Field of Greens Advisory Council at info@fieldofgreensfund.org or call Caroline Trost at (615) 397-4091. Grant funding for qualified applicants to the Field of Greens Fund for Fall 2011 of grants up to $1,000. All applicants must complete each section of the application and submit the application, along with a completed W-9 form (available online http://www.irs.gov/pub/irspdf/fw9.pdf?portlet=3), no later than August 1, 2011 in order to be considered for funding during this round. Incomplete applications will not be returned and will not be considered. Section One 1. Name of Farmer/Producer 2. Business Name of Farm 3. Contact Name (if different) 4. Mailing Address

City

State

Zip Code

County

5. Daytime Phone Number(s) 6. Email Address 7. Physical Location/Address of Farm (if different from above or if you operate additional locations): 8. Percentage of Family Income from Farming? 9. Please describe your farm how many acres in production, types of crops/animals raised, number of people including family members involved, marketing outlets and methods, etc.:

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10. Please provide some information about your sustainability practices. Refer to Application Guidelines for a description of sustainable farming. Attach additional pages if necessary.

Section Two 11. Please describe the reason why you are applying for a grant from the Field of Greens Fund (natural disaster, injury, development or growth opportunity, or other). Feel free to attach additional pages if necessary, and please be sure to include farm name on any additional pages.

12. If funding is sought as a result of a natural disaster, injury or damages of any kind, list other funding sources, if any, providing financial assistance for the same:

13. Please provide detailed information, including any written documentation, receipts, photographs or any other sources that help support your application for funding from Field of Greens. If you are submitting additional supporting information by mail, please note that here.

14. Please provide contact information for at least one professional reference who can verify that you are a farmer and practice sustainable farming practices. References can include a representative of an agricultural association or network you are a part of, a farmers market organizer, another professional farmer, or a technical service provider such as an extension agent. Name of Reference:

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Title and Company: Relationship to You: Mailing address, daytime phone number(s) and email address:

Attach list of other references if you wish.

Section Three I understand that this application is for a maximum grant of up to $1,000. I understand that the funds provided by the Field of Greens Fund is to be used by me for the purposes described by me in this application and will provide documentation supporting this fact if requested. I certify that all the information in this application form is complete and correct to the best of my knowledge. If the information in this application changes, I will inform Community Food Advocates/Field of Greens Fund. I agree that Community Food Advocates/Field of Greens Fund has the right to validate any information provided and will reclaim any money that has been paid as a result of fraudulent or misleading claims. Signature 1

Printed Name

Date

Completed applications for the Fall 2011 grant funding through the Community Food Advocates Field of Greens Fund and a completed W-9 form must be received by email or U.S. Mail no later than August 1, 2011. Email is preferred, even if the W-9 and any supporting documents are sent by U.S. Mail. Applications that are not complete or are received after that date will not be considered for Fall 2011 grant funding, but may be resubmitted for Spring 2012 funding.. The applicant will be
1

If submitting by email, your electronic signature will suffice and will be considered equivalent to a handwritten signature. Simply type: /s/ followed by your name.

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notified if his or her application is incomplete or too late to be considered for this round of funding. Completed applications should be emailed as a PDF or Microsoft Word attachment to application@fieldofgreensfund.org or mailed to: Field of Greens Fund Application Review c/o Friends of the Nashville Farmers Market P.O. Box 68316 Nashville, TN 37206 Members of the Advisory Council for the Field of Greens Fund will be available to answer questions related to this program and the application and review process. Please contact us at info@fieldofgreensfund.org or call Caroline Trost at (615) 397-4091 with any questions.