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Makah Foundation Well Request
Please use this form to request a well from Makah Foundation.
Applicant Name (First and Last Name) *
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Applicant Email Contact *
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Applicant Phone *
Your answer
Name of Village Chief/Quarter Head/Pastor/Head Master Supporting this Request *
Your answer
Contact Information for Chief/Quarter Head/Pastor/Head Master *
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Name of Organization/Community to be Served by the Well *
Your answer
Number of People in the Organization/Community that will be Served by the Well *
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Current Walking Distance to Water Source (in km) *
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Quality of Existing Water Source *
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Names of Four Volunteers (First and Last Names) Who Can Help With the Well Installation *
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Do you feel that your community/organization deserves special consideration? *
If you answered 'yes' to the previous question, please explain.
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