Community Borehole

REACH OUT FOR CHARITY FOUNDATION

STRENGTHENING COMMUNITIES UNITED KINGDOM
COMMUNITY BOREHOLE PROJECT

Community Contact Person
Name

First NameLast Name
Position / Title

Other
Please specify.....
Phone Number

country CodePhone Number
Email (if available)
example@example.com
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Community Details
Name of Community / Village / Area:

Street Address Line 2

Local Government Area (LGA):State

Zip CodeCountry
Borehole Need Assessment
Is there currently a source of clean water in the community?
If yes, what is the condition of the existing source(s)?
Estimated number of people who will benefit from the borehole: ___________
Proposed Borehole Location
Proposed Site (landmark, address, or GPS coordinates if available

Street Address Line 2

CityState / Province

Postal / Zip Code
Who owns the land?
If Individual please provide the name and contact of the individual: ___________
Is the land donated for the borehole project?
Community Contribution & Support
Will the community contribute to the project (e.g., labor, materials, security)?
Is there a designated committee or person to manage the borehole after installation?
If yes, name of committee or person: ___________________________
Declaration & Consent
Please read the following statements carefully and tick the boxes to indicate your agreement.
Should be Empty:

REACH OUT FOR CHARITY FOUNDATION