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* Indicates Required Fields
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1.
*Are you a 501 (c)(3) not-for-profit organization or a government agency (including public schools)?
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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.
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1.
*Requesting:
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*Organization’s Legal Name:
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*Contact Name:
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*Organization Address:
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*Email Address:
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e.g.email@email.com
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*City:
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*Phone:
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e.g.888-888-8888
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*State:
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Fax:
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*Zip:
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e.g.12345
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Impact Area
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What is the organization’s mission?
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What population(s) does the organization serve? (check all that apply)
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Geographic Location:
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Number of full-time staff members:
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Number of part-time staff members:
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List of organization’s source of income (e.g. annual campaigns, fundraising, donors, federal/state funding)
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Minimum length of board/committee member service requested/required:
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Board/Committee meeting frequency:
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Board/Committee meeting length:
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Board/Committee meeting location:
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Is committee involvement mandatory for board members?
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If yes, please list committees with open positions.
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Any additional time commitments for board/committee members (mandatory events/programs)?
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If yes, please list specifics.
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Does your organization require a financial commitment from board/committee members?
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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.)?
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What level of American Water Board Member are you seeking?
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List any specific skills or areas of expertise (e.g. marketing, legal, etc.) you are seeking
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List any interesting organizational history and accomplishments
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List any other board member responsibilities not previously discussed
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List any other issues and/or information that would be of interest to a potential board/committee member.
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Does the organization have Directors and Officers insurance?
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