FYN Voucher Intake Form

With charitable donations and community partner funding, Prescott Farmers Market may provide Feed Your Neighbors (FYN) vouchers to be used towards purchasing food staples of vegetables, fruit, nuts, herbs, eggs, bread, milk and meat from our vendors. 

There is currently a waiting list to be accepted into the FYN voucher program.

Please complete this intake form to be added to the waiting list and to be contacted for additional assistance while the waiting list is in place.

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Email *
First & Last name
First & Last names of all household members who may pick up vouchers.
Phone number where you can be reached for program check-in.
How many adults are currently living in your household? *
How many minors are currently living in your household?  Please list the ages.
Are there other food assistance programs your household currently utilizes? (select all that apply) *
Are there additional food assistance programs that you would like information on regarding their resources? (select all that apply) *
How long do you anticipate needing FYN assistance to buy veggies, fruit and pantry staples? *
How did you hear about the FYN program? *
What's your zip code? *
Please carefully read the terms of agreement below and select boxes for each term with which you agree.
Thank you for completing this form. PLEASE KEEP A COPY FOR YOUR RECORDS. Contact marie@prescottfarmersmarket.org or TEXT 928-458-8425 for questions or changes in your need of food assistance.
A copy of your responses will be emailed to the address you provided.
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