Railyard Herbal Justice Fund Request Form
Who is eligible?
-BIPOC (black, indigenous, people of color) folks and senior citizens regardless of income
-Those who may self-identify as meeting one of the following criteria:
Living on fixed government income (SSDI, SSI, Social Security, unemployment)
Receiving public assistance
Paying 50% or more of income for housing
Are struggling to support children or other dependents
Have significant debt
Have medical expenses not covered by insurance
If you meet eligibility, please answer the following questions:
Which services would you like to access? (sliding scale costs listed for members of the herbal justice program)
walk-in consultation (10-30 minutes) ($2.50-30)
2-hour consultation ($30-125)
1- hour follow- up consultation ($15-60)
herbs and/or herbal formulation (up to $50 value per month is available)
classes (variable, average full price is $20, discount is up to 40-100% off)
How much are you able to pay out of pocket per month?
How did you hear about this program?
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This form was created inside of Emma Merritt.