Farmer’s Market Nutrition Coupon Program Application 2024

NOTE: Submissions for the 2025 Farmer’s Market Program are not currently being accepted. Please come back in May 2025 to submit your application.

Please provide us with the following contact information.

Name

Phone/Text

Email

Address

City

State/Province

Zip/Postal

Country

About You:

What is the total number of people in your household?

In your household, how many people are:

Under 19 years of age?

Pregnant?

Seniors/Elders?

Do you identify as Indigenous?

Yes

No

If you identify as Indigenous, do you identify as any of the following?

First Nations

Metis

Inuit

OtherOther

Are you a refugee?

Yes

No

Are you able to afford adequate amounts of fresh fruit and vegetables for you/your family?

Yes

No

Does most of your income come from government assistance (CPP, OAS, GIS, Income Assistance, PWD)?

Yes

No

The 2024 Fernie Mountain Market operates from 10am-2pm every Sunday, from July 7th – Sept 29th. Can you commit to regularly participating in the Farmers Market Nutrition Coupon Program?

Yes

No

We are actively looking at ways to support our participants. Do you have any concerns regarding picking up your coupons or attending the market? If so, check what applies:

Health and safety concerns

Transportation

Other – Please describe:Other – Please describe:

Program Guidelines:

Coupons must be collected according to the following Pickup Schedule:
- July Coupons:
  - Sunday July 7^th at The Market, or
  - Between 11am – 1pm on Thursdays or Fridays at the Fernie Women’s Resource Centre.
  - *Last day to pickup is Friday July 26^that the Women’s Centre.
- August Coupons:
  - Sunday August 4^that The Market, or
  - Between 11am – 1pm on Thursdays or Fridays at the Fernie Women’s Resource Centre.
  - *Last day to pickup is Friday August 23^rdat the Women’s Centre.
- September Coupons:
  - Sunday September 1^stat The Market, or
  - Between 11am – 1pm on Thursdays or Fridays at the Fernie Women’s Resource Centre.
  - *Last day to pickup is Friday September 20^th at the Women’s Centre.
Coupons not collected by the last pickup day of each month will be given to someone else on the waitlist, but your enrolment in the program will not be affected. You will still be able to collect the following month’s coupons.
If you need someone else to pick up your coupons, notify us beforehand.
Due to high program demand, participants must be consistent in redeeming their coupons.
Please notify us and return your coupons if you wish to leave the program.
Waitlist participants will be notified if and when coupons are available.
Coupons are to be used for locally grown fruit, vegetables, herbs, dairy products, eggs, nuts, meat, fish and honey, but not for any prepared foods (breads, baked goods, jerky, meat sticks, jams, etc.).
Market Vendors will have a ‘coupon poster’ to signal that they will accept the coupons.
Market Vendors will not give change for FMNCP coupons.
Coupons cannot be sold, traded, or duplicated.

Consent

By selecting this box, I consent that I have read and agreed to the Farmers’ Market Nutrition Coupon Program Guidelines, and the Coupon Pickup Schedule. If my application is selected, I agree to be a part of the Farmers’ Market Nutrition Coupon Program. I understand the program provides fresh, local food for those who face financial challenges. I understand that these coupons are for my family’s personal use only.

Participant Name

Date

Farmer’s Market Nutrition Coupon Program Application 2024