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Sabine
River Authority of Texas
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FY-2010
Community Assistance GRANT Program
Application Form
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Each entity must submit a completed Community
Assistance Grant Application form to be considered for FY-2010 funding.
The form must be postmarked or faxed (to meet deadline) no later
than February 15, 2010. If faxed, the original must be sent by
mail. Forms postmarked after the February 15, 2010 deadline will
not be accepted.
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(Please type or print the requested information
below)
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Entity Information
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Name of Entity (County/City/District
etc.)
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Address
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County
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City State ZIP Code
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Contact Person
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FAX No.
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Telephone No.
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Email Address
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Project Description Provide
a brief description of the Project. Refer
to Grant Application Instructions for details. Additional sheets may be added if needed.
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Project Category - costs could include feasibility studies,
materials or construction costs for:
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Check one
Category that best describes the purpose of the Project
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A.
Water Supply System – Permitted capacity of a Water Supply System
is being expanded or additional facilities are needed for growth.
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B.
Wastewater Management – Permitted capacity of a Wastewater
Treatment System is being expanded or additional facilities are needed for
more stringent limits.
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C.
Water Conservation - Promotes or improves water use
efficiency.
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D.
Water Quality -
Promotes or improves instream water quality.
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Requested Amount: (up to $10,000)
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$_________________
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Local Commitment: (Amount of Local Funds)
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$_________________
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In-Kind Services: (Describe and value)
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$_________________
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Other Sources of Funds: (Describe)
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$_________________
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Total Project Costs:
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$_________________
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Links to Other State/Federal Loan or
Grant Programs: (Identify program and
status of approval)
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Signature of Legally Authorized Public
Official
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Printed Name and Title of Applicant’s
Authorized Representative
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Phone Number:
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Signature of Authorized Representative
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Date:
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