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4 <br />Nor~h Carolina WaterlWastewater Common App[ication ~orm <br />For use by ARC, CWMTF, DENR, DOC, and Rurcrl Center applicants. <br />A en Use Onl <br />In an effart to streamline the applica6on process, North Carotina funding agencies created this common <br />appEication form for applicants to utilize when requesting water/wastewafer grantiloan funds. Additional material <br />rec{uired by eacf~ funding agency can be found in the appendices. <br />Guidelines: • <br />• Fully complete each section of this application form <br />o Be sure to include all additional information requested by involved funders (found in <br />appendices) <br />~ Pfease refer to appendices for the number of copies required by each agency. <br />o!f a project is requesting CWMTF and Rural Cenfer funds, the ftalEy execuied cammon <br />application form shauld be sent to both CWMTF and the Rural Center. in add'+tion to the <br />common application form, each agency shoutd rece+ve its additionaE requested material only. <br />See indivictual agency guidelines for other -naterial needed for each applicatian. <br />Descrip#ive Project Title: McGowan Creek {nterceptor <br />(7itle shoutd sfay consiste~stwrith each <br />agency request) <br />Incficate the status of this application: <br />~ NEW APPLICATiON <br />^ REVISION <br />^ RESUBMITTAL <br />. Former project tit(e: <br />Select organizatidn(s) invalved in #his request (check all that apply} <br />^ ARC Appalachian Reqional Commission <br /> Date submitfed <br />^ CWMTF Clean Water Manaqemen# Trust Fund <br /> Date submitfed <br />~ DENR-CW NC Dept of Environment and Nafural Resources (Clean Water} <br /> Da#e submitted ~ <br />^ DENR-DW NC Dept of Environment and Natural Resources (Drinkinq Water) <br /> Date submitted <br />^ DOC NC Depf. of Commerce <br /> Da#e submitted <br /> ~ CDBG (~CA) <br /> ~ . CDBG-ED (CFG) <br /> ~ IDF CFC . ' <br />^ NCREDC NC Rural Economic Development Center <br /> Date submitted " ~ <br />Page 1 of 5 <br />Version 09/10 <br />