StateofConnecticut
DepartmentofAgriculture
BureauofRegulatoryServices
450ColumbusBoulevard,Suite702
Hartford,CT06103
Licensing(860)713‐2512AGLicensing@ct.gov
ProduceSafety(860)713‐2522ProduceSafety@ct.gov
Voluntary CGAPEnrollment
This produce and/or sprout growers who wish to participate in the Voluntary CGAP Program.
If application is incomplete, or if a Federal Employer IdentificationNumber(FEIN)orSocial Security Number(SSN)isnot
supplied or is different from a previous years filing, application will be returned for completion and resubmission.
REQUIRED
Federal Employee
Identification
Number (FEIN)
Or Social Security
Number (SSN)
REQUIRED
SoleProprietorLimitedLiabilityCompanyCorporationPartnership
Farm / Business Name Phone:
List all DBA’s, if any: Email:
Address: Fax:
City: State: Zip:
Mailing address or address business correspondence should be sent if different from above:
Manager or Most Responsible Person Onsite: Phone:
Growing, Harvesting, Holding, and/or Packing of Fruits & Vegetables intended for human consumption occurs in the following
months:
January February March April May June July August September October November
December Year-Round Crop Plan Completed: YES NO (see reverse)
Check all activities that apply: Outdoor Grow Acres: _______ | Indoor Grow Sq. Ft. ________ | Hydroponics |
Aquaponics | Packing | Washing | Cooling | Storage |
The undersigned applicant states they are authorized to sign legal documents on behalf of the business listed above and that
all of the information contained herein is true and accurate to the best of his/her knowledge, and agrees that in the event a
registration is issued the registrant shall comply with C.G.S. § 22-39g and any regulation adopted thereunder and any orders,
ruling or directive issued by the Commissioner of Agriculture or the commissioner’s authorized agent.
PRINTED NAME OF APPLICANT DATE
SIGNATURE OF APPLICANT
For Agency Use Only:
FEE AMOUNT
RECEIVED
Not
Applicable
CHECK OR MONEY ORDER
Not Applicable in 2019
DATE PROCESSED
TRANSMITTAL
NUMBER
REGISTRATION
EXPIRATION
Voluntary Connecticut Good Agricultural Practices (CGAP) for growing, harvesting, packing and holding produce is a voluntary certificate program,
open to all size farms regardless of income. Participants will be subject to the requirements of CGAP, C.G.S. § 22-39g and the applicable regulations.
