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2. Income-Qualified Garden In A Box Program Application Form
4. First Name*
5. Last Name*
6. Email*
8. Do you pay the Town of Frederick directly for your water?*
9. Utility Account Number*
10. Phone Number*
12. Address*
14. City*
15. State
16. Zip*

18. To qualify for the Income-Qualified Garden In A Box Program, applicants’ household income* must be equal to or less than 60% of the Town of Frederick’s median household income. The limit is $76,207 (based on the Town of Frederick’s 2025/2026 community profile with a median income of $127,011).

    * “Household income” is the adjusted gross income from your tax return plus any excludible foreign earned income and tax-exempt interest you receive during the taxable year. Household income also includes the incomes of all of your dependents who are required to file tax returns because their income meets the filing threshold. Household income does not include a dependent’s income if the dependent’s income is below the filing threshold, even if they choose to file a return for another reason (for example to claim a refund of withheld income tax). IRS.gov.

19. Income Qualification*

    1. By checking this box, I certify:

    My household income is less than or equal to $67,394

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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