LIC CSA Subsidized Share Application
Please fill out this form if you are interested in our subsidized share program. LIC CSA can offer a few discounted shares each season. Answer questions honestly and to your best ability. You will be contacted upon approval soon.

Si necesitas ayuda en Espanol, por favor escribes a con las palabras "Subsidy" y "Espanol" en la linea de asunto.

Email address *
Name/Nombre *
Your answer
Address/Direccion de casa *
Your answer
Phone/Telefono *
Your answer
Email *
Your answer
Do you currently use the Hour Children Pantry? Cómo se utiliza el banco de alimentos Hour Children? *
What is your household income/ingresos del hogar? *
How many adults are in your household? ¿Cuántos adultos viven en su casa? *
How many children are in your household? ¿Cuantos niños? *
Do you receive any of the following benefits? ¿Usted recibe estos beneficios? *
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