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 application.
  2. Income level - – to be eligible on the basis of income, recipients’ gross household income must not exceed the following limits:
$1,605.00 monthly……for a household of ------1
$2,163.00 monthly……for a household of ------2
$2,721.00 monthly……for a household of ------3
$3,279.00 monthly……for a household of ------4
$3,838.00 monthly……for a household of ------5
$4,396.00 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 2014 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.

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 Information
  • (Please use middle initial only)

  • Last Four Digits of Social Security Number:
Recipient Contact Information
  • If you wish to receive a confirmation email that your application has been received, you must enter a valid email address.
  • (Please use (555) 555-5555 format [include area code])

Household Information
  • $
  • In order to verify that an actual person - not an automated software script - is submitting this form, please type the 2 words below in the box provided. If you can't read the words, click the blue "Get a new challenge" button.
  • Please read and agree to the following statement before typing your name in the box below.
  • The name you type above is used as your electronic signature. By typing your name in the box, you signify
    that you agree with the information in this section and that the information you provided is accurate to the best of your knowledge.