Good Food Bucks Supplemental Funding Request Form
Good Food Bucks Program Partner Retailers may use this form to request additional nutrition incentive funds for their approved market location. Awards of supplemental nutrition incentive funds is contingent on Partner Retailers meeting program requirements, complete or near-complete expenditure of awarded nutrition incentive grant funds, and availability of program funding. Supplemental nutrition incentive funding is not guaranteed and will be made at the discretion of City Green, Inc.
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Please notify us via email at GoodFoodBucks@City-Green.org that you have submitted this supplemental funding request form. Not doing so may result in a delayed response regarding your supplemental funding approval. Thank you!
Date of Supplemental Funding Request *
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Your Name: *
Email Address: *
Name of Market for which you are requesting Supplemental nutrition incentive funding: *
What is the value ($) of Good Food Buck nutrition incentives that have been distributed at your market during this grant cycle to date? *
What is the value ($) of Good Food Buck nutrition incentives that have been redeemed at your market during this grant cycle to date? *
How many SNAP transactions have occurred at your market during this grant cycle to date? *
How many markets have you held since the start of this grant cycle to date? (i.e. total # of market days you've held to this point)
From this date forward, how many additional markets will be held during this grant cycle? (i.e. # of markets remaining in your season) *
Is there any additional information you would like to share with City Green regarding your need for additional nutrition incentive funds?
Thank you for your request!
Should your request for supplemental Garden State Good Food Network nutrition incentive funding be approved, your Primary Program Contact will receive a letter and additional grant agreement from City Green, Inc., which must be signed and returned. City Green will reach out to your Primary Program Contact and/or the individual submitting this request should any additional information be required. Reach out to us at GoodFoodBucks@city-green.org with any questions or concerns!
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