Would you like to submit your declaration online using this form, or would you like to upload a photo or scan of your declaration?(Required) Online form Upload Declaration UploadUpload your file here Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 15 MB, Max. files: 5. Farm Name(Required) Farm Name(Required) Please select which certification type(s) you hold.(Required) Produce/flowers Livestock Apiary Mushrooms Aquaponics I (we) declare and affirm that the information submitted via the Certified Naturally Grown (CNG) application is correct and accurate, and that all information will be kept current, complete and up to date to reflect any changes.(Required)Please initial. I (we) have read and understood the appropriate CNG standards, and our practices adhere to the requirements listed therein.(Required)Please initial. I (we) understand that Certified Naturally Grown reserves the right to remove us from the program and deny us the use of the CNG logo and marketing materials for any reason including concerns that we don’t adhere to CNG standards, or have missing or misleading information on the application.(Required)Please initial. I (we) declare and affirm that I (we) will only represent products as Certified Naturally Grown when they actually meet the certification standards and come from a Certified Naturally Grown operation.(Required)Please initial. Please select which of the following statements applies to your apiary: I (we) declare and affirm that the brood comb in our apiaries have never been exposed to coumaphos (CheckMite+), fenpyroximate (Hivastan), Tylan or more than two treatments of fluvalinate (Apistan, Mavrik) or amitraz (Miticur, Taktic, or Mitak) AND all the brood comb originated in our apiaries (no nucs). 40% or less of our brood comb may have been exposed to Tylan and/or 3 or more treatments of fluvalinate or amitraz, and/or came from another apiary, but I (we) don’t use any prohibited treatments now. Please select which of the following statements applies to your produce, flower, and/or livestock operation(s):Please choose one. I (we) declare and affirm that all the land for which we are applying for Certified Naturally Grown status has been free of prohibited pesticides, herbicides and fertilizers for at least three years (36 months) from the date of our first saleable harvest this year. The land is still within the 36 month transitional period, but I (we) don’t use any prohibited pesticides, herbicides and fertilizers now. I (we) declare and affirm that all the substrate used to grow CNG mushrooms meets CNG standards, and does not contain heavy metals or byproducts of GMO crops.Please initial. The container/s used for pasteurization and/or sterilization... meet CNG standards will be replaced within two months not applicable Please initial.Please initial. The fruiting room racks... meet CNG standards will be brought into compliance within twelve months not applicable Please initial.Please initial. The outdoor production area... does not contain pressure treated wood used to elevate logs will have such pressure treated wood removed within two months not applicable Please initial.Please initial. Name(Required) First Last Email(Required) Date(Required) Month Day Year Signature(Required)Please sign your name. Reset signature Signature locked. Reset to sign again PhoneThis field is for validation purposes and should be left unchanged. Δ
