Survey of interest in receiving free plant starts in conjunction with participating in the Fairfield Garden Initiative Program

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Thank you for your interest in the Fairfield Garden Initiative Program. Please fill out and submit this form to express interest in receiving free, healthy plant starts for your garden. This is a survey of interest and is not an order. Filling out this form does not guarantee access to free plant starts.

Email *

Name *

Zip code *

Phone number *

Number of people in household *

I certify that I meet LMI Eligibility limits for this program. Is you household income at or below the 80% MFI for Jefferson County, Iowa? https://sustainablelivingcoalition.org/wp-content/uploads/Jefferson-County-80-lmi-Fairfield-Garden-Initiative-limits-effective-6-21-2021-.pdf *

Yes

I am not sure

Other:

Please check all the plants you're interested in growing.

Asian Greens (Bok choi, tatsoi, etc)

Broccoli

Cabbage, Green

Cabbage, Red

Cauliflower

Chard, red/white/rainbow

Collard Greens

Cucumber, Pickling

Cucumber, Snacking

Eggplant

Herbs, Basil

Herbs, Chives

Herbs, Cilantro

Herbs, Oregano

Herbs, Parsley

Herbs, Sage

Herbs, Thyme

Kale, Curly

Kale, Dino (lacinato, black)

Pepper, Sweet (bell, roasting)

Pepper, Hot (jalapeno, chili)

Squash, Butternut

Squash, Summer

Squash, Winter

Tomatillo

Tomatoes, Cherry

Tomatoes, Paste for sauce

Tomatoes, Slicers

Zuchinni

Other:

Did we miss any of your or your families favorite annual fruits or vegetables on the list above? If so, please list some of those.

Are you interested in receiving seed for plants that are better suited for direct sowing? If you are interested in receiving seed for direct sowing for the '22 garden season, please choose from the list below.

carrots

beets

pole beans

bush beans

sweet corn

lettuce

cilantro

dill

turnips

okra

summer squash

winter squash

pumpkins

spinach

kale

swiss chard

Other:

Clear selection

Do you have extra, vital seeds to share? Would you be interested in participating in a seed swap?

Yes

Maybe

Other:

Clear selection

Do you have a garden plot at your residence already? *

Yes

Maybe

Other:

What is the approximate square feet of your garden space?

If you don't have a pre-existing garden plot, do you have space for installing a garden plot?

Yes

Maybe

Other:

Clear selection

Are you space limited or would you prefer to develop a container garden scenario this season?

Yes

Maybe

Other:

Clear selection

If you have or are planning to install a garden, do you have access to a hose and a water hookup? *

Yes

Maybe

Other:

Please rate the probability of you activating your garden or starting a new garden this '22 gardening season. *

Not likely this season, but check back for the '23 season

I am willing and ready to get gardening

Please offer any addition comments that you feel will help make the implementation of this program successful.

GDPR Agreement *

I consent to having this website and the Fairfield Garden Initiative Program store my submitted information so they can respond to my inquiry.

Required

Thank you for submitting your interest. We will keep you in the loop and connect back soon with more details.

A copy of your responses will be emailed to the address you provided.

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