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Loan and Grant Program Application
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* Indicates required question
Name (first and last):
*
Your answer
Street Address (street, city, state, ZIP code):
*
Your answer
City:
*
Your answer
ZIP Code:
*
Your answer
City Ward # (To find your Ward visit
tucsonaz.gov/files/pdsd/2013_Ward_Map_11_x_17.pdf
):
*
1
2
3
4
5
6
Outside of City of Tucson limits
Telephone number:
*
Your answer
Email address:
*
Your answer
Do you own or rent your home?
*
Own
Rent
What is your language preference?
*
English
Spanish
Other:
Required
Tucson Water Account #:
*
Your answer
Is your account in good standing with Tucson Water? (If your account is not in good standing, you cannot participate in the program until the matter is resolved.)
*
Yes
No
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