Local Foods Connection - Referral Form for CSA Share
Please use this form to refer new LFC clients to the Local Foods Connection organization. Individuals or families who join LFC after the referral and welcome meeting process will be enrolled in a 18-20 week CSA with a local farm (free of charge). If you have questions about the form or referral process, please call or email Tommy Hexter at 540-471-1647 or info@localfoodsconnection.com.  

Before making a referral, please review your responsibilities as a LFC Community Partner.  We would appreciate referrals that understand our mission statement and what we're trying to offer.  Also, please know that while we would like to fund everyone, we're working with a limited budget.  If you feel an individual, family, or agency would be an exceptional fit, please advocate for them in the comment section at the end.  

Link to Community Partner Role Letter:
https://docs.google.com/document/d/1wOP-wT_fMP_apM9wwIfjTTv98BSg_QFijrKwwltzytU/edit?usp=sharing
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Proposed client's name:  *
Is the referral an individual or family? *
Proposed client's email:  *
Proposed client's phone number:  *
Proposed client's address: 
How many adults live in the home of the proposed client? *
How many children live in the home of the proposed client?
Does the proposed client meet the income guidelines for LFC? *
The LFC mission is to serve low-income residents in our community.  The 2021 FPL is $12,880 for an individual, plus $4,540 for each additional family member ($26,500 for a family of 4).  This low figure often times leaves a number of people in our community without federal services.  To help fill this gap in services, LFC serves people who earn up to 200% of the FPL (i.e. double the current FPL). We will not ask for documentation on a client's income status - we just ask that community partners make referrals in good faith.
Does the proposed client fit into any of the following groups? *
The LFC mission is to serve those who fall into one of these categories - please select any that apply.
Required
Notes or additional information you'd like to provide.  
Thank you for your referral
We will be in touch if we have additional follow up questions. If you need to get in touch with us please try one of the avenues below.  Thank you again for being an LFC Community Partner!

Local Foods Connection Contact Information
Address - 1032 Main St, Grinnell, IA 50112
Phone - 540-471-1647
Email - info@localfoodsconnection.com
Website - https://www.localfoodsconnection.com/

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