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Sabine
River Authority of Texas
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FY-2008
Community Assistance GRANT Program
Application Form – Water Supply Corporations
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Each entity must submit a completed Community
Assistance Grant Application form to be considered for FY-2008 funding.
The form must be postmarked or faxed (to meet deadline) no later
than September 19, 2008. If faxed, the original must be sent by
mail. Forms postmarked after the September 19, 2008 deadline
will not be accepted. (Please
type or print the requested information below)
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Entity Information
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Name
of Entity (Water Supply Corporation)
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CCN
#
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Address
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County
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City State ZIP Code
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Manager
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FAX
No.
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Telephone
No.
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Email
Address
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Non-Profit/Member-Owned
WSC (Y/N)
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Customers
Served (#)
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Annually
Audited (Y/N)
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Date
of Last Annual Audit
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Year
Established
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Subject
to Open Meetings Act (Y/N)
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Subject
to Open Records Act (Y/N)
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Previous
Funding Sources (within the last 10 years):
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Source
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Project Type
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Amount
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Date
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Federal
(Specify)
________________________
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___ Loan
___ Grant
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___
Water
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Wastewater
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Water Conservation
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Water Quality
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State
(Specify)
________________________
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___ Loan
___ Grant
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___
Water
___
Wastewater
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___
Water Conservation
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Water Quality
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Local
(Specify)
________________________
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___ Loan
___ Grant
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___
Water
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Wastewater
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___
Water Conservation
___
Water Quality
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Project Description Provide
a summary description of the Project.
Additional information should be attached as needed.
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Project Category - costs could include materials, equipment 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 WSC
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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