2024 Senior Farmer's Market Nutrition Program (SFMNP) Application

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This program is seasonal - April 1st to October 31st. Once the program is full , new applicants will be added to the waiting list. But don't worry! We'll let you know if we get to that point in time when a waiting list is needed! Please complete the information requested below and certify that all the information provided are true and correct. Mahalo!

First Name *

Last Name *

Birthdate *

YYYY

Gender *

Male

Female

Mailing address (include apartment or unit number) *

City *

Zip code *

Phone number *

Email address *

Number of people in my household *

Participation in SFMNP is limited to households with incomes that meet the program's annual income requirement. Please review the following annual income maximums based on household size.

1- person household income less than $32, 023.50
2- person household income less than $43,475.00
MAX annual income for household of 3+: Add $11,451.50 for each additional household member (including children)

My household annual income *

I certify under penalty of law that ALL of the following statements are true and correct: *

My household does not exceed the annual income requirement designated above.

I am at least 60 years of age.

I reside in Hawaii County.

I am making only one (1) request for ten (10) Senior Farmer's Market Nutrition Program (SFMNP) food coupons for the 2023 program year.

Required

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