2018-2019 Well Aware Project Request Form
Thank you for your interest in a water project with Well Aware.
Well Aware solves water scarcity problems in East Africa with sustainable water systems. Projects are reviewed based on viability, potential impact, and several other factors.

Water systems are designed by our engineers and hydrogeologists in collaboration the community. They are funded by our network of donors, implemented by our team in Africa, and maintained by the community and their water committee.

Well Aware implements a limited number of projects each year. To request a new project, please ensure all requirements are met and provide as much information as possible. Thank you.

Email address *
Community Information
Community Name *
Your answer
Community Location (COUNTRY) *
Your answer
Community Location (COUNTY) *
Your answer
Total Community Population *
Your answer
Community coordinates (or directions from closest town) *
Your answer
Requestor Information
Requestor relationship to community *
Your answer
First & Last name of requestor *
Your answer
Email address *
Your answer
Phone number *
Your answer
Current date *
MM
/
DD
/
YYYY
How did you hear about Well Aware?
Your answer
Additional Project & Community Information
Describe the community situation and water need (Include current water sources, their distance from community, reliability, etc.) *
Your answer
Expected Project Type *
Please list all existing water infrastructure in the community (Boreholes, rain water collection, water storage, water kiosk, etc.) Details on condition & size.
Your answer
Please list all existing community facilities (schools, health clinics, etc.) Details on condition & population served daily.
Your answer
Is there a functioning water committee in the community?
Would this project be in partnership with another organization?
If "yes" to the question above, which organization? (give additional details)
Your answer
Is the proposed site for the water project on community property and is a land deed available?
Is there currently any corruption or tribal conflict in the community?
List any nearby boreholes, distance from community, depth, pump type, yield, water quality, has it gone dry? (please include available borehole reports)
Your answer
List any springs in the area, distance to community, if it flows all year, if temperatures change, if it has ever gone dry.
Your answer
Describe the rainy seasons, when they start & end, how much rain is expected.
Your answer
Are there any crops and/or livestock in the community?
If "yes" to the question above, please list the corps or livestock kept and the water source used to water them.
Your answer
Please describe any latrines and hand-washing stations/ practices in the community.
Your answer
Is the community struggling with certain diseases? How far is the nearest clinic? Are health records kept?
Your answer
Are there any wildlife threats to the community?
If "yes" to the above question please explain.
Your answer
Is there a reliable source of electricity in the community?
Was there a previous clean water source that failed?
What was the previous source?
Your answer
Why & when did it fail?
Your answer
When was it installed and who installed it?
Your answer
Well Aware contact info
Additional documents (land deeds, borehole reports) can be emailed to kareece@wellawareworld.org
For local assistance in Kenya, please contact mike@wellawareworld.org.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Well Aware. Report Abuse - Terms of Service