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Community Garden Program

2013 Reduced Rate Application

 

Applications must be complete and include all necessary documentation to be accepted.  Please call Megan to schedule a time to submit your application and payment.  (303) 443-9952

 

 Applicant Information: (please print) 

 First Name: ______________________ Last :_________________________________ 


Street Address: ______________________________________ Apt or Unit #________ 


City________________________ ZIP: _______________ 


Phone: _________________________ Email: __________________________________ 

 

 

In order to qualify you must be able to provide one or more of the following:


Public Housing

Must be able to provide documentation that you are living in public housing.


Medicaid

A copy of a current Medical Authorization Card (MAC) OR a letter of verification of the Medicaid status. 


Colorado Health Plan (CHP)

A current copy of CHP card. 


Proof of Disability Other than Medicaid

An Adult with a disability may attach proof of disability. Proof : proof of SSI or SSDI, a letter stating your disability status from an agency or physician.   


Signature

 

X____________________________________________Date____________________

 
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