Contact Information

Name*
You have to be 18 years of age to apply
Preferred contact, check all that apply*

Applicant's Address*
You must enter an address to determine eligibility. 

Please indicate your race-ethnicity(ies) Select all that apply:*

Income Details

retirement, employment, etc
Full name
$
Full name
$
Full name
$
Full name
$
Full name
$
Full name
$
Full name
$
Full name
$
$
Including applicant and any other household members earning income

Survey

Are you the primary food purchaser?*
Enter name
Are you willing to provide receipts from your food purchases?*
Do you have access to reliable internet?* Participating in this program does not require internet access.*
Are you currently receiving a compost collection service?*
Would you prefer Spanish interpretation and/or translation for training sessions and written materials?*
Are you an employee of the City of Phoenix? *

Below is the list of activities you are expected to commit to if you are selected for the program. Failure to complete these tasks will result in dismissal from the program.

The resident agrees to complete the following activities:

  • A 15-min introductory survey on demographics and health
  • Two follow-up 10-min surveys throughout the year
  • Weekly 1-2 min surveys
  • Weekly food waste collection
  • Optional: Partake in an in-depth interview upon completion of the program.
I hereby declare that all the information contained in this application is in accordance with facts or truths to my knowledge. I take full responsibility for the correctness of the said information.*

You must agree that all the information contained in this application is in accordance with facts or truths to your knowledge. You take full responsibility for the correctness of the said information. This form is disabled if you do not agree.

Before you submit this form, please be aware of the city's policy on use of its systems. The message you are about to send is subject to public disclosure under the Public Records Law. It is not private or confidential and is retained for 90 days.

*You must complete all required fields before submitting.

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