American Water Grant Application 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?
       To view a map of the American Water service footprint, please click here.       

ORGANIZATION INFORMATION

Date of Application:   *Executive Director:
*Organization’s Legal Name: Contact Person/Title:
 (if different than Executive Director/President)
*EIN or Federal Tax Identification Number: *Email Address:  e.g.email@email.com
*Address (Principal Office): Website URL:  e.g.http://www.amwater.com
*City: *Phone:  e.g.888-888-8888
*State: Fax:
*Zip:  e.g.12345
*Brief Description of Your Organization:

PROPOSAL INFORMATION

Request Type (please check all that apply):




Investment Focus Area (please check all that apply):



*Purpose Of Grant:


Beginning Project Date:   Ending Project Date:
*Grant Amount Requested: Total Project Cost:
American Water Contacts (who have you contacted at American Water regarding this project?):
American Water Volunteers (list the names of all American Water employees who are significant volunteers or are board members for your organization)
Which of the following underserved populations will you be serving with this program (please check all that apply):




Copy of current IRS determination letter indicating 501(c)(3) tax-exempt status (if a non-profit organization):



If requesting funding of $5,000 or more, please submit a project budget (including information on other funding sources and/or potential funding sources and amounts committed or requested for the project, if any).

 

  © 2010 American Water. All Rights Reserved | Privacy Policy | Terms of Use | Site Map Puddles