Herbal Justice Fund Application

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Please complete this form to request financial assistance through Railyard Apothecary's Herbal Justice Fund. When we receive your application we will notify you if we are able to accept you into the program at that time or if you will be added to a waitlist.

To be eligible for assistance you must currently reside in Vermont and identify as one of the following:

1.) BIPOC (black, indigenous, person of color)

2.) Person with limited resources, defined as meeting one of the following criteria:

Living on fixed government income (SSDI, SSI, Social Security, unemployment)
Receiving public assistance
Unemployed
Houseless
Paying 50% or more of income for housing
Are struggling to support children or other dependents
Have significant debt
Have significant medical expenses not covered by insurance

If you have questions, please contact info@railyardapothecary.com

Email *

Please check each eligibility criteria you meet *

BIPOC (black, indigenous, person of color)

Person with limited resources

Required

Do you currently live in Vermont? *

Yes

Other:

Have you previously participated in the Herbal Justice Fund? *

Yes

Other:

First Name *

Last Name *

What are your preferred pronouns? *

Email address that you can be reached at (this is the primary method of communication we will use for the program) *

Phone number that you can be reached at (XXX-XXX-XXX) *

How did you hear about the Herbal Justice Fund? *

What services are you interested in utilizing through the Herbal Justice Fund (HJF)?
*

What you select here is not binding - we are just trying to gauge interest in the different services. All of these services will be available to you as a member of the Herbal Justice Fund.

Bulk herbs: monthly stipend towards bulk dry herbs, bulk herbal tinctures, bulk herbal powders, and herbal blends made using the above products

Consultations: 75% of costs for clinical services through the Railyard Apothecary Clinic, with a limit of 1 consultation/month per individual

Classes: full and partial scholarships are available for select classes

Required

How much of a monthly stipend towards bulk herbs will you need? *

Please be honest about what level of financial assistance you require. If you are able to select a lower stipend, it will enable us to offer the program to more community members. Please, however, only select a lower stipend level if it feels appropriate for you.

$25/month

$50/month

Do you certify that all of the information you provided on this form is current and accurate? *

Yes

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

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