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SOUTHWESTERN WATER CONSERVATION DISTRICT <br /> Request for Financial Assistance <br /> Instructions: Completion of this application form is required in order for the District to <br /> consider requests for financial assistance. It should be typed or printed legibly with black ink. <br /> In order to facilitate preparation of this Request an MS WORD version is available on the <br /> internet at www.swwcd.org. Please attach additional sheets as necessary to fully answer any <br /> question in order to assure that all information that might be helpful in evaluating your <br /> application is considered. Please return the original signed copy of this application to <br /> Southwestern Water Conservation District and retain a copy for your records. Please Return to: <br /> Southwestern Water Conservation District <br /> Attn: Requests for Financial Assistance <br /> P.O. Box 475 <br /> Durango, CO 81302 <br /> PART A: DESCRIPTION OF AUTHORIZED ENTITY <br /> 1. Name of Authorized Entity: River Protection Work Group <br /> 2. Type of Entity(Please check 1) <br /> public entity ❑nonprofit corporation <br /> ❑ not-for-profit corporation ❑ carrier ditch company <br /> ❑ mutual ditch or reservoir company ❑ unincorporated ditch or reservoir company <br /> ❑ cooperative association x Other(please attach a separate sheet <br /> explaining the legal basis upon which the <br /> District may be authorized to offer your <br /> entity financial assistance) See attachment 1 <br /> Mailing Address: <br /> 3. Business Phone Number: Janice Sheftel 970-247-1755, Chuck Wanner 970-259-3583 <br /> 5. Email Address:jsheftel@mbssllp.com , cwanner @frontier.net <br /> 6. Federal ID#: N/A <br /> 7. Person to Contact Regarding Application: <br /> a) Name Chuck Wanner <br /> b) Position/Title Water Issues Coordinator SJCA <br /> c) Address PO Box 2461,Durango, CO 81302 <br /> d) Business Phone Number 970-259-3583 <br /> e) Other Phone Number 970-259-0075 <br /> f) Email Address cwanner @frontier.net <br /> PART B: DESCRIPTION OF PROJECT <br /> 1. Name and location of Project-Please provide a name by which the project is to be <br /> known as well as a physical location. If available please attach a legal description, <br /> otherwise identify the county and approximate distance and direction from the nearest <br /> town. <br />