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)? YesNo
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. Yes (if yes, please indicate community)No (if no, you cannot receive a grant)
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): Financial Contribution to Project or Program Financial Contribution to Event (e.g. watershed clean-up) Contribution of Property, Equipment or Materials Contribution of Volunteer Labor Sponsorship
Investment Focus Area (please check all that apply): Water and Healthy Living Water and the Environment Environmental Education Community Sustainability
*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): Low income communities Senior citizens Environmental Education None Unknown
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).

American Water Grant Application Form

ORGANIZATION INFORMATION

PROPOSAL INFORMATION