“GREEN” GRASS Enrollment Form

Name___________________________________________ E-mail ___________________________

Address_______________________________________ Town ___________________ Zip________
Subdivision________________ Day Phone:________________Evening Phone:_________________

Preferred method of being contacted is: _____day phone ______evening phone _____ e-mail
___Yes, I am a resident of Fauquier County.
I want to join “Green” Grass. As a participant of the “Green” Grass program, I give my permission for
a representative (volunteer usually) from the Virginia Cooperative Extension Fauquier Office to come
onto my property to take soil samples and lawn measurements. I understand that the base fee ($20)
covers one soil test and provides program materials. Enclosed is a check for program fees of $20.
Signature (required)________________________________ Date____________________________

Please make the check payable to “Treasurer, Virginia Tech.” Mail or hand deliver with application to:

“Green” Grass Program, VCE-Fauquier

24 Pelham St.
Warrenton, VA 20186
For questions about the program, please call the Horticulture Help Desk at: 540.341.7950 ext 19

1. Residence:
• Approximate year house was built. ____________
• Do you keep your pets outside while you are not at home? ____ yes ____ no
• Are you on a private well/septic system? ____ yes ____ no
2. Lawns: (check all that apply)
I have a ____front lawn _____ back lawn _____ side lawn
Was the lawn newly seeded in the last year? ____ yes ____ no; If so when ___________
3. Grass Type:
• What type of grass do you have?
____ Cool Season (e.g. fescue, bluegrass)
____ Warm Season (e.g. zoysia, Bermuda)
____ Do not know
2
• What is the approximate area of your lawn area in square feet? ________ ft _______ don’t know
• Do you over-seed your lawn at least annually? _____ yes _____ no _____ don’t know
• Do you employ a lawn service? _____ yes _____ no
• Has lime been applied to your lawn within the last year? _____ yes _____ no ____don’t know
• Rate the appearance of your lawn. ____ poor ____ fair ____ good ____ excellent
Extension is a joint program of Virginia Tech, Virginia State University, the U.S. Department of Agriculture, and state and local governments. Virginia Cooperative Extension programs and employment are open
to all, regardless of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, or marital or family status. An equal opportunity/ affirmative action employer. If you are a person
with a disability and desire any assistive devices, services or other accommodations to participate in this activity, please call 703-792-6285 / 800-828-1120 TDD) during business hours of 8 a.m. and 5 p.m. to
discuss accommodations 5 days prior to the event.
5. Fertilizer application:
• Has your lawn been fertilized in the last 12 months? ____ yes ____ no ____ don’t know
• Check each month that you fertilize.
___January ___ February ___ March ___ April ___ May ___ June
___ July ___ August ___ September ___ October ___ November ___ December
• Do you know how much fertilizer was applied? ____ yes ____ no
If yes, what were the Nitrogen-Phosphorus-Potassium (N-P-K) numbers on the bag?
(e.g. 10-10-10, 29-3-4 )
_______ N-P-K ____ number of bags ____ weight per bag
_______ don’t remember
• Annually, how much do you estimate you spend on fertilizer for your lawn? $____________
• Annually, how much to you estimate you spend on total lawn care? $ ________________
6. Irrigation / Watering:
• Do you water your lawn? ____ yes ____ no
• If yes, how many times per week? _______
• Do you have an irrigation (sprinkler system) installed in your lawn? ____ yes ____ no
7. Aerating:
• Do you aerate your lawn annually? ____ yes ____ no
8. Past soil testing:
• Have you had your soil tested within the last 3 years? _____ yes _____ no _____ do not know
If yes, please answer the following:
° What year? ________
° Was it through Cooperative Extension? ____ yes ____ no
9. Mowing:
• I mow my grass to a height of: ____ more than 3” ____ 2-3” ____ less than 2”
• Do you remove grass clippings from the lawn? ____ yes ____ no
If yes, do you ____ compost clippings ____ throw clippings in the trash
10. Water Quality:
• Do you believe lawn care practices affect local water quality? ____ yes ____ no

In an effort to reduce paper, Virginia Cooperative Extension encourages you to request

your Customized Fertilizer and Lime Plan be sent to you via email.
• Would you like your Plan to be sent as an attachment via email?____ yes ____ no

OPTIONAL:
Demographics: Virginia
Cooperative Extension programs
are open to all. Please help us
measure our effectiveness at
reaching all people by voluntarily
completing the information here.