Full Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you or your farm/ranch insured? *

If you are applying for a health-related issue please answer in terms of health insurance coverage.

Yes

No

How much money are you applying for? *

Project funding outside of the $500 emergency grant range is subject to additional requirements and may not exceed 10% of the fund balance or $2,000 maximum.

$500

Other

Mailing Address(if Different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Requirements for $500 emergency grant requests *

I am a current and active TFM Association member

I acknowledge that this grant will be reported to the IRS

With my application I am emailing ed@texasfarmersmarket.org with photos of the damages or losses (if applicable) and written estimates detailing cost of repairs for which funding is requested, estimates on items to be purchases or actual invoices to be paid as backup information for my request to be considered.

Upon completion of project or use of funds, I agree to provide documentation confirming how the funds were used within 90 days. Final report will also include a detailed summary of how funds assisted your farm/ranch and a photo of the completed work.

I agree to a potential inspection of the scope of the project if deemed necessary

N/A - I am applying for another amount

Certify Request *

"I do certify by checking this box that the above information is correct. I understand that falsification of any information provided on this application will disqualify me from the grant."