Preliminary Project Information Form “Non-Profit Project Financier” Fields marked with a * are required. 1. Type of Organization * Non-ProfitLocal, County, State GovernmentQuasi-Governmental OrganizationOther 2. Organization Information Name: * Address: * City: * State: * Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: * Phone: * Fax: Website Address: 3. Contact Information First Name: * Last Name: * Email Address: * Phone: * 4. Type of Project * RenovationNew ConstructionBio-Mass PlantMicro-GridWaste Water Treatment FacilityInfrastructure Improvements What is to be renovated? What is to be constructed? Has a site been chosen? YesNo 5. Has a Construction Company been chosen for this Project? * YesNo 6. Project Costs (Estimate): * 7. Amount of Funding Requested: * 8. Project Timeline. When do you want to begin this Project? * Within 3 monthsWithin 6 monthsWithin the year I Want You To: *
