Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697800239516.pdf (Dominica)
Registration form CERC Micro Garden Programme THE CONTINGENCY EMERGENCY RESPONSE COMPONENT (CERC) THE EMERGENCY AGRICULTURAL LIVELIHOODS AND CLIMATE RESILIENCE PROJECT MINISTY OF BLUE AND GREEN ECONOMY, AGRICULTURE, AND NATIONAL FOOD SECURITY REGISTRATION FORM CERC MICRO GARDEN PROGRAMME This programme targets farmers and gardeners with areas of land from 3,000 to 10, 000 square feet.
Applicants who qualify under the Dominica Emergency Agricultural Livelihoods and Climate Resilience Project (World Bank funded project) are not eligible to apply.

This initiative focusses on food production to enable household consumption during the COVID 19 pandemic, hereby contributing to national food security.

ONLY Social Security form of identification will be accepted.

Seeds will be distributed based on your planting square footage.
In addition to seeds, inputs such as tools, seedling trays, potting soil and agrochemicals will be provided as a package.

If conditions agreed to by the applicant is not adhered to, the project will Terminate this Agreement.
GUIDING NOTES Eligible participants include: resident Dominicans, non-nationals and immigrant residents willing and able to utilize their available space to the efforts RESPONDENT DETAILS / BIO - DATA First Name: ______________________ Last Name: _______________________ Alias: ________________________ Dependents: ___________ D.O.B.
: DD__/M __ Yr _______ Gender: Male _______; Female________ SS # __________________ Contact Number: _______________ Email Address: ______________________ Address: __________________ Community/ Village of residence where micro garden is situated: ________________ Direction to Micro – garden: _________________________________ No.

of Persons in Household: ________ No.


Persons willing and able to work in back-yard garden _______ Is there anyone in the home at high risk to COVID 19: o Yes o No If yes, please indicate the number of persons: _______ MICRO PARTICULARS Size of micro garden: Length _____________ Width: ________________ Which is your main source of water supply (check all that applies): o Rain Water o River/stream o DOWASCO o None Which of the following water conservation methods do you practice?
o Tanks o Drums o Mulching o None o Other Visible and significant presence of snails and slugs: o Yes o No o Other pests: ______________ CROP OPTION Please select vegetable cropping option.

Please note of the importance of well balanced mix.
Choose from list of crops: Leafy vegetables: Cabbage Lettuce Kale Spinach Root vegetables: Carrot Beets Radish Fruit vegetables: Tomato Seasoning Pepper Bell Peppers Cucumber Okra Legumes: String Beans Lima Beans Vines: Pumpkin Watermelon Cantaloupe Eggplant Exotics: Broccoli Cauliflower Zucchini Culinary Herbs: Basil Rosemary Parsley Celery Chive Onions Carbohydrate: Sweet Corn ENVIRONMENTAL CONCERNS Use of kitchen waste in composting: o Yes o No How often do you use external sources of Organic Matter?
o Always o Sometimes o Seldom o Never SOCIAL CONCERNS 12.

Are you willing to share harvest with Social Welfare Organizations: o Yes o No 12a.

If so, indicate from the list below; o Home for the aged - Portsmouth _____ Mahaut _____ Roseau _____ o Chances o Grotto o Operation Youth Quake o House of Hope o Health Care Facilities Commitment Agreement Clause Subject to the Terms and Conditions of this Agreement, I ___________________ will hereby ensure that the information provided on this form is true.
I will provide the required conditions stipulated by the project such as (land, water) for the execution of a micro garden.

I will also commit to using the inputs given to me for the purposes agreed to by the project.

Signature of Applicant: ________________ Date: _______________ Signature of Witness: _________________ Date: _______________