SW EFC Water and Wastewater Assistance Program: Intake Form

This form is for systems looking to recieve assistance through the SW EFC Water and Wastewater Assistance Program. Please fill out the form and we will reach out with more information and next steps.


Eligibility for the program:

  • Drinking water, wastewater, and stormwater systems
  • Located in EPA Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas)
  • Seeking assistance for projects that will include (or may include) an infrastructure component.

John Doe, johndoe@water.org, (555) 555-5555

Select all that apply.

Select
Caret IconCaret symbol

NOTE: Only states in EPA Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) are eligible for assistance through this program.

Select or enter value
Caret IconCaret symbol

If no, select "No" at the top of the dropdown list. If yes, please select the tribe.

Select or enter value
Caret IconCaret symbol
Select or enter value
Caret IconCaret symbol

Summarize in ~250 words or less.