SCRP Tier II Application

Small System Capacity and Resiliency Program Tier II - Grants for Small Drinking Water Systems at Risk of Failure

Applications due Monday, December 2, 2024
Name of applicant (governmental unit)
EIN
Primary contact

First NameLast Name
E-mail
example@example.com
Phone number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Describe the proposed use of funds.
Describe the history, issues, events, etc. that contributed to the current crisis.
How will the proposed project resolve the crisis and reduce the risk of failure?
Why is the proposed project the best solution?
What else do you plan to do to reduce failure risk moving forward? (Describe any plans for improving the sustainability / resiliency of infrastructure, operations, and/or administration practices as appropriate.)
Amount of Grant Request
$

Project Sources & Uses

Describe the commitments to the project from other sources. Include terms as appropriate.
Estimated project start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Estimated project completion date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Documentation supporting requested grant amount (e.g., contracts, bids, etc.)

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FY 2023 financial statements (balance sheet and statement of revenues and expenses - audited if possible)

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YTD or FY 2024 financial statements (balance sheet and statement of revenues and expenses - audited if possible)

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Financial projections that include at least one post-project completion year showing operating expenses, debt service expenses, and revenues sufficient to cover all expenses. (A model is available below.)

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Click here to download an enterprise financial projection model. You are not required to use the model. However, please note that the quality of your financial projections may be considered in scoring your application.
Describe plans for realizing projections. Please touch on any anticipated changes to rates, number of connections, etc.

Top Five Rate Payers - with revenues collected from each in a recent 12-month period

Customer Profile - number of customers by type with revenues collected from each in a recent 12-month period

Number of households served (if different from number of residential connections above)
Average annual household drinking water cost (if different from residential customers / revenues)
$
The information provided in this application is true and accurate and the contact on the application is authorized to submit the application.
I agree to the above statement
Should be Empty:

Small System Capacity and Resiliency Program Tier II - Grants for Small Drinking Water Systems at Risk of Failure