Statewide Acequia Improvements ApplicationPlease fill out the application below. Application Date: MM DD YYYY Applicant / Entity: Address Address 1 Address 2 City State/Province Zip/Postal Code Country County Federal Employer Identification Number (EIN) as issued by the IRS: Are you a part of a regional acequia association? What acequias are located in your geographical area? Primary Contact Person First Name Last Name Contact Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Project Description Complete the following information in the provided space below. Include any additional documents that may be useful in reviewing this project, i.e. architectural designs, feasibility studies, business plan, etc. Proposed Project Start Date MM DD YYYY Proposed Project Completion Date MM DD YYYY When do you need NMAC funds available? How will the ongoing maintenance, operation, and replacement of this project be funded? NMAC Funds Requested $ Other Public Funds* $ Private Funds $ Total $ Planning and Design $ Construction $ Equipment $ Facility Acquisition $ Land Acquisition $ Utilities (Electric, Gas, Water, etc.) $ Engineering and Architectural $ Contingencies $ Project Administration / Legal Fees $ Other $ Total Cost $ Specify any other public funds, and amounts and terms of these funds. Please include the source, amount and terms / number of years Will this project require right-of-way acquisition? Yes No Do you need planning, construction, design funds? If so, please explain. Is this project going to be executed in phases? If so, please describe any plans below. Thank you for completing the application!