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Financial_Assistance_Questionnaire_v7

The CCOF Certification Financial Assistance Application allows individuals and organizations to apply for fee waivers based on various criteria such as being underserved, having limited resources, or experiencing hardship. Applicants must provide personal and operational information, including details about ownership and financial status. Submitting financial documentation is optional but can support the application, and all information will be kept confidential.

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1 views2 pages

Financial_Assistance_Questionnaire_v7

The CCOF Certification Financial Assistance Application allows individuals and organizations to apply for fee waivers based on various criteria such as being underserved, having limited resources, or experiencing hardship. Applicants must provide personal and operational information, including details about ownership and financial status. Submitting financial documentation is optional but can support the application, and all information will be kept confidential.

Uploaded by

huaytaparimarcos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CCOF Certification Financial Assistance Application

Fill out this form to apply for financial assistance for CCOF certification fees.

FEE WAIVERS ARE AVAILABLE FOR:

Underserved Producers in the United States 100% Female or Nonbinary Owned


Limited Resource Operations in Mexico Operations
Hardship – Declared Emergency Schools/Nonprofits
Previously Incarcerated Individuals Veterans

CLIENT INFORMATION:

OPERATION NAME: CLIENT CODE:


New Applicant:
Yes
No
OWNER NAME:
First Last

Mailing Address
Street Address Unit # Town/City State Zip Code

Street Address
Street Address Unit # Town/City State Zip Code

Personal Email

What most closely Is your operation a nonprofit or school that offers


describes your gender? education on organic production practices? Yes No

What is your racial or


ethnic heritage? If yes, do you sell organic products for a profit? Yes No

QUESTIONS:

If the operation is not 100% wholly owned, provide the following information about all other owners:

Owner Name(s) Racial/Ethnic Heritage Gender Description % Owned


1. What was your gross annual income from organic production last year (in U.S. dollars)?

2. Describe your hardship with as much detail as possible:


Please include: What was the hardship? Who/what did this hardship affect? When did it occur?

3. Is this need related to a State or Federally Declared Emergency? YES NO


If yes, what declared emergency were you impacted by (e.g., wildfire, flood)? Please list below

4. Are you a veteran of the armed forces? YES NO

5. Have you ever been convicted of a felony and served time in prison? YES NO

FINANCIAL DOCUMENTATION
Submission of financial documentation is not required but helps us understand your financial need.
Documentation could include any of the following:

Your federal income tax returns, W-2s, and other records of money earned
Bank statements and records of investments (if any exist)
Records of untaxed income (if any exists)
Any information regarding ownership of small businesses and/or other assets

ACKNOWLEDGMENT AND RELEASE

I hereby certify that all information submitted on this application is true and correct to the best
of my knowledge. I understand that all information contained here is subject to verification and
that false information will lead to disqualification. I understand that CCOF Certification Services,
LLC will keep all financial and demographic information confidential.

Authorized Signature

Date

Please email this completed form to [email protected] or mail to


CCOF, 2155 Delaware Avenue, Suite 150, Santa Cruz, CA 95060

California Certified Organic Farmers®


©2020 CCOF Certification Services, LLC; CCOF, Inc.; CCOF Foundation
T: (831) 423-2263 | F: (831) 423-4528 | [email protected]

Release: 10.1.2023 (831) 423-2263 www.ccof.org

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