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  Kansas Public Water Supply Loan Fund
Project Submittal Form
 
Fill in form, print and mail to:

KDHE – Public Water Supply
Building 283 – Forbes Field
Topeka, KS 66620

Please provide as much information about the project as possible, so the project can be ranked accurately. Rural water districts need to include the number of meters by township, so points for median household income can be determined.

1. Applicant Name:
2. Mailing Address:
3. Person Completing Form:
Title:
Phone:
4. Project Description:
5. Purpose of Project:
6. Estimated Project Start Date:
7. Estimated Project Construction Start Date:
8. Estimated Project Cost: