Engineers Without Borders
541 Community Application for a Community Engineering Corps
ProjectThank you for your interest in submitting a project
application for the Community Engineering Corps. Before you
continue, please be sure to read the instructional document that
can be found at www.communityengineeringcorps.org The 541 Community
Application for a Community Engineering Corps Project is due by
8:00 a.m. Mountain Time on the first and third Monday of every
month.
The Application Review Committee will review the application and
respond to the submitter within 4 weeks.
Note: Community Engineering Corps does not provide cash
donations or grants to communities. Community Engineering Corps
provides engineering expertise to communities or community based
organizations. Community Engineering Crops will generally provide
no funding for the construction of facilities implemented with a
partner community or community based organization.SECTION A:
General Information1. Todays Date:
2. Please check one of the following boxes:
FORMCHECKBOX New Project Submitted by NGO and/or community-based
organization with no ASCE, AWWA, EWB-USA partner chapter or section
affiliation
FORMCHECKBOX New Project Submitted by NGO and/or community-based
organization in conjunction with ASCE, AWWA, EWB-USA partner
chapter or section (chapter or section has will submit a 542 -
Chapter or Section Application to Acquire a Community Engineering
Corps Project to adopt this project) with this 541
applicationPlease provide the following information if this
application was prepared with an ASCE, AWWA, EWB-USA partner
chapter or section:
Name of Chapter(s) or Section(s): Chapter or Section Contact
person:
Chapter or Section E-mail Address:3. State/County (or
State/Tribe if a tribal community partner):
4. Community Name:
5. Community Geographic Coordinates: Google Earth may be used to
determine coordinates. Use degrees and decimal degrees for
latitude, longitude.
For example: 36.012199, -114.741142
SECTION B: Contact Information
1. Organization
a. Name of Requesting Organization:b. Website of Organization:c.
Mission of Organization:2. Primary Contact Person
a. Name:b. Title:c. Contact Email:d. Contact Phone:e. Contact
Address:3. Primary Project Facilitatora. Name:b. Title:c. Contact
Email:d. Contact Phone:e. Contact Address:
SECTION C: Project Information
1. Please check ONE project type that best describes the
services and needs addressed by the first proposed project.
____ Water Supply
____ Sanitation (examples latrine, gray water system, black
water system, etc.)
____ Structures (examples bridge, building, etc.)
____ Civil Works (examples road, drainage, dam, etc.)
____ Energy (examples fuel, electricity, etc.)
____ Agriculture (examples irrigation, fish farm, crop
processing equipment, soil improvement, etc.)
____ Information Systems (example computer service)
____ Other please describe2. Describe the proposed project.
Provide background information for the proposed project. There
should be sufficient information to allow the reader to understand
the context of the project.3. Describe the problem that the
proposed project is intended to solve.4. What previous work has
been done to solve the identified problem?
5. Who will own the facilities constructed in the project?
6. What are the anticipated positive impacts from this
project?
7. What are the potential negative impacts from this project?8.
Additional Information: Please add any other information you think
is relevant to this project. 9. How many people will be affected by
this project in a certain geographic region (please provide an
estimated NUMBER of people affected -- not a description)
a) Directly Affected:
b) Indirectly Affected:
c) Geographic Area (5km radius, town, region etc.):
SECTION C: Community Description
1. Describe the community that is the beneficiary of the
proposed project. Define the community (for example, The
beneficiary community includes the 100 members of the community
garden cooperative). Please describe the economic status of the
community.
2. Why has the community not been able to complete this project
using their own resources?
3. What will the partner community and community based
organization contribute to the assessment and implementation of
this project?
4. What will the partner NGO contribute to this project? If
there is no partner NGO please state that.
SECTION E: Signatures and Pictures
1. Please add pictures that may be helpful to understand the
project.
Please add pictures as JPEG files WE WILL NOT ACCEPT PROJECT
APPLICATION FILES THAT ARE OVER 2MB.
(To add a picture as a jpeg, go to Edit ( Paste Special, and
choose Picture (jpeg))
2. Please attach a letter of support from the community if the
application was not prepared by the community or the community
based organization.3. Please sign and date this
form:____________________________________________________________________________________
Signature
Date
____________________________________________________________________________________
Printed Name
E-mail Address
5) Submission information: Please email this application in MS
Word format (it must be less than 1MB) to:
[email protected] 2014 Community Engineering Corps. All
Rights Reserved Page 4 of 5
