American Water Board Member Request Form

* Indicates Required Fields

1.  *Are you a 501 (c)(3) not-for-profit organization or a government agency (including public schools)?
 2. *Is your project or organization located in a community served by American Water or one of its subsidiaries?
       To view a map of the American Water service footprint, please click here.
1.  *Requesting:


*Organization’s Legal Name: *Contact Name:
*Organization Address: *Email Address:
*City: *Phone:  e.g.888-888-8888
*State: Fax:
*Zip:  e.g.12345  
Impact Area

What is the organization’s mission?

What population(s) does the organization serve? (check all that apply)

Geographic Location:  
Number of full-time staff members:
Number of part-time staff members:

List of organization’s source of income (e.g. annual campaigns, fundraising, donors, federal/state funding)
Minimum length of board/committee member service requested/required:
Board/Committee meeting frequency:
Board/Committee meeting length:
Board/Committee meeting location:
Is committee involvement mandatory for board members? `

   If yes, please list committees with open positions.
Any additional time commitments for board/committee members (mandatory events/programs)? `

   If yes, please list specifics.
Does your organization require a financial commitment from board/committee members? `

   If yes, please list the minimum required amount.
   What qualifies as the minimum amount (e.g. personal contribution, corporate contribution, matching contribution from employer, fund raised, etc.)?

What level of American Water Board Member are you seeking?

List any specific skills or areas of expertise (e.g. marketing, legal, etc.) you are seeking

List any interesting organizational history and accomplishments

List any other board member responsibilities not previously discussed

List any other issues and/or information that would be of interest to a potential board/committee member.

Does the organization have Directors and Officers insurance? `


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