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.
Or Social Security
Farm / Business Name Phone:
List all DBA’s, if any: Email:
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
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:
CHECK OR MONEY ORDER
Not Applicable in 2019
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.