Senior Farmers Market Nutrition Program Application

This is a secure application. An application must be completed for each person in the household that qualifies for SFMNP benefits. Applicants must reapply every year. You can apply for next year’s program any time after January 1st. To qualify, individuals must meet the following criteria:

  1. Age - person must be 60 years of age or older the day of issuance.
  2. Income level - – to be eligible on the basis of income, recipients’ gross household income must not exceed the following limits:
$1,580.00 monthly……for a household of ------1
$2,133.00 monthly……for a household of ------2
$2,685.00 monthly……for a household of ------3
$3,238.00 monthly……for a household of ------4
$3,816.00 monthly……for a household of ------5
$4,344.00 monthly……for a household of ------6

(Household: a group of related or non-related individuals living together as one economic unit. These amounts are at 165% of 2013 Federal Poverty Guidelines.)

No person is “entitled” to Senior Farmers Market Nutrition Program checks, i.e. the budget does not allow enough checks to satisfy everyone who wants them and is eligible.

Must have Internet Explorer 6 or higher to complete form (Upgrade Internet Explorer). When you are entering information in the form below please do not enter unnecessary punctuation or symbols. Please be very careful and ensure that your address is your correct mailing address.

Recipient Name / Date of Birth
  • (Please use middle initial only)
  • (Please use 4/19/2014 format)
Recipient Contact Information
  • (Please use (555) 555-5555 format [include area code])
Race/Ethnicity








Household Information
  • $
Verification
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Submission
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