Ithaca Organics Farm ~ 2017 Healthy Food For All Solidarity (subsidized) CSA Share Application ~
Sign me up! For 23 weeks (mid-June through mid-November) of abundant locally grown, organic produce!
Spaces are limited and reserved on a first come, first serve basis. To ensure your space, fill out and submit this application and send in your check today!

Send deposit to:
Ithaca Organics: 85 Simms Hill Rd. Dryden, NY 13053

To pay using Cash, EBT-Food Stamps or Credit Card please contact us.

***PLEASE NOTE- Your space in the CSA is NOT reserved until your DEPOSIT is RECEIVED by the farm.***
Thanks!

Questions? Please get in touch! phone: 607.844.3435 or email: IthacaOrganics@aol.com

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SPECIAL INFORMATION regarding our shares:

Ithaca Organics offers Boxed CSA Shares and Ithaca Farmers Market 'Free Choice' CSA Shares. Please read the following information and make sure you select the proper share for your household and location.

Boxed Shares are pre-boxed shares available weekly for pick-up at ALL Ithaca Organics pick-up sites, Ithaca, Freeville, Dryden, Homer and Lansing . Boxed shares are available in 2 sizes:
Small Boxed Share- $210
Large Boxed Share- $276

Market 'Free Choice' Shares allow members to pack their own shares each week from the market booth at Sunday Market at Steamboat Landing in Ithaca OR at Tuesday Market in Dewitt Park. OR on Thursday at Jerry Dell farm in Freevile. 'Free Choice' Market Shares are available in 3 sizes AND are based on how many adults live in your household (shares are also available for households with more than 3 adults, contact the farm for information):
Single Person Market Share (1 adult only) - $216
Small Market Share (2 adults) - $225
Large Market Share- (3 adults) - $334 (+59.50 for each additional person)

Name
Your answer
Address
Your answer
Phone number(s)
Your answer
Email
Your answer
Income Eligibility Charts
please refer to the charts below and confirm that you are income eligible for the HFFA Solidarity CSA Share.
My household is income eligible for HFFA Solidarity CSA Shares
Please refer to the above charts and confirm that your household is income eligible. Eligibility is determined by gross income (before taxes) and family size.
I am applying for the following Ithaca Organics CSA Share
Please refer to the share descriptions above. Please make sure you check the correct share type!
BOXED share pick-up location:
please choose the location that you will pick-up your BOXED share
MARKET share pick-up location:
please choose the location that you will pick-up your FREE-CHOICE share
I understand that this is a binding agreement, on my part to provide financial support to the farm and for the farmers to provide me with food. I also understand that farming is a natural process and that weather may influence the amount and diversity of produce I receive.
Please read and indicate if you agree to the above statement
I would like to pay for my CSA using EBT-Food Stamps
If using EBT to pay for your deposit, please contact the farm.
Important note regarding EBT! HFFA is happy to take EBT payments for your CSA share! EBT payments can be made at Greenstar Cooperative Market. After making your EBT payment at Greenstar, you MUST save your receipt and provide it to your farmer ASAP as proof of payment. If you fail to provide your Farmer with a copy of your EBT payment receipt, your payment will not count! HFFA CSA members are also eligible to become members of Greenstar's FLOWER program. FLOWER members receive a 15% discount off most products purchased at Greenstar! And membership can automatically verify CSA payments made via EBT at Greenstar.
for more information on the FLOWER program please visit http://www.greenstar.coop/flower or contact healthyfoodforall.ithaca@gmail.com.
Healthy Food For All is made possible through grants that require us to report the following information. Your answers will remain strictly confidential. Thank you.
How many adults are in your household?
Your answer
How many children are in your household?
please also indicate their ages
Your answer
Is your household a single-parent family?
a single-parent family as defined by one parent who lives with their dependent child(ren) alone -or- in a larger household without a partner.
Do any of the children in your household attend Beverly J. Martin Elementary School?
Do any of the children in your household participate in programs at GIAC and/or Southside Community Center?
Please indicate which programs you participate in:
please check all that apply
Did you participate in a CSA last year?
How did you hear about Healthy Food For All?
please check all that apply
On average, how many servings of fruits and vegetables do you consume in a week?
1 serving = 1 cup salad or 1/2 cup cooked vegetable or 1/2 cup fruit
Your answer
On average, how many servings of fruits and vegetables do the children in your household consume in a week?
Your answer
On average, how many different types of vegetables do you consume in a week?
Your answer
On average, how many different types of vegetables do the children in your household consume in a week?
Your answer
What ethnicity do you identify with?
Your answer
How often to you check your email?
***PLEASE NOTE- Your space in the CSA is NOT reserved until your DEPOSIT is RECEIVED by the farm.*** Thanks!
if you plan on paying your deposit with EBT/Food Stamps, please contact the farm
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