Orcas Island Fresh Bucks Program Application and Affidavit for Eligibility

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The Fresh Bucks program provides up to a $20 benefit each purchase to buy locally grown fruits and vegetables and Produce Basics.

Email *

Name *

Number in Household

Address

Phone *

Are you a co-op member

Yes

Clear selection

You are a resident of San Juan County *

Yes

Based on the size of your household your income is

1 person/ $2,023 a month /$24,276 a year

2 people/ $2,743 a month / $32,916 a year

3 people / $3,463 a month / $41,556 a year

4 people / $4,183 a month / $50,196 a year

5 people/ $4,903 a month / $58,836 a year

6 people/ $5,623 a month / $67,476

Add for each person over 10: $720 a month

Clear selection

I am a WIC or EBT enrolled family (you are automatically eligible for this program)

Yes

Clear selection

By Selecting the Yes option, I Certify that I am eligible for the Fresh Bucks Program *

YES

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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