PIF Membership Application

PIF applications are reviewed on a monthly basis, or whenever funds are available. Applications may take one month to process. Pay It Forward Memberships are free and are awarded by a lottery system based on funding we have available at the time. This means that recipients of free Pay It Forward memberships will be selected at random, and will be granted memberships when funds are available

PIF memberships are equivalent to one $30 investment into a member share, which will activate your member benefits for a full calendar year. In order to reach full equity at the Co-op, folks invest $180 over a long period of time. If you would like to reach full equity (member for life), you must reapply for PIF annually, or you may continue to invest in your share yourself if you find you have the funds to do so.

Who is Eligible to Apply?

Anyone who is experiencing financial hardship can apply. This includes folks who already have a Co-op Membership but cannot afford to make their next share payment.

We encourage folks who use Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Oregon Health Plan, and Temporary Assistance for Needy Families (TANF), as well as those experiencing unemployment and students, to apply.

We do not check these credentials. This is an honor-based program. With increasing costs of food and living, we understand that many people are experiencing financial hardship and do not qualify for government assistance programs. We encourage anyone who receives a low income to apply.

Name of Primary Shareholder

The membership will legally be under this name and only the Primary Shareholder can run for the Board, and vote in elections.

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

What is the best way to contact you?

You must provide either a phone number or email address for us to contact you, if you are awarded a PIF Membership.

Phone

Are you currently a Member-Owner or do you have a Double Up Food Bucks Number?

If you have a Member number but your membership has lapsed, you should still answer "yes."

If you already have a Member# or DU#, please enter it here:

Would you like to opt in to the Food For All Program, which will give you an additional 5% off your groceries, if you are awarded a PIF membership?

Please Review & Check the Following:

I understand that if I am awarded a PIF Membership, that it is the equivalent of one $30 investment in your member share, which will activate my membership benefits for 1 year.

I understand that in one year, when the next $30 installment of my member share is due, that I will either: a) reapply for PIF to cover one more year of my membership, or b) make the membership payment on my own, if I am able.

I understand that if I do not renew my membership, my member benefits will pause until I choose to renew my membership.

PIF Membership Application

Who is Eligible to Apply?

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