Water Testing Interest Form
At this time only Linn County has remaining funds, the other 2 county programs have ended. We have applied for additional funding but will not know the status until Jan 2026. You are welcome from any county to fill out the interest form - but only Linn will be contacted currently.

Linn County - A few tests remain for homeowners - fill out the form below. 
Benton County - No tests available - Program has ended
Clackamas - No tests available -Program has ended

The Oregon State University Extension Service is partnering with Crossroads Community (Linn), Benton County Health Department, and the Clackamas County Health Department to offer free domestic well water quality testing for nitrate, arsenic and coliform bacteria in Linn, Benton, and Clackamas counties to qualifying applicants. Please fill out this form to learn more and see if you may qualify for this service.

This is a grant funded program so the amount of tests we can provide to community members is limited. Each grantor may have different reporting requirements. We will encourage you to share any results with the Oregon Health Authority through their online system.

For this form in Spanish: https://beav.es/GwD 
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Full Name *
Address the well is located at. Include street and city *
Are you the.......? *
What county is the domestic well located in? *
Email address *
Phone number  *
Number of people in the household *
Do you qualify for any income based programs such as SNAP, WIC, Medicaid, etc? This is for informational purpose and would not disqualify or qualify you.  *
Are you or anyone in your household a veteran? *
What is your households yearly income? *
By checking this box I agree to having an OSU representative come to the domestic well location to collect a sample and perform a brief well and/or septic system assessment with me. 

Sample collection depends on many factors, but our preference is to collect from the location that most of your drinking/cooking water comes from. 
 *
Required
If you are accepted into this program we require your attendance at an educational class put on by OSU Extension Service. Do you agree to this?

In-person and webinar options are available. The sessions required are based on your individual water quality results, but will be no longer that 3ish hours - snacks/meal and attendance incentives are provided.  
 *
* We provide results on OSU letterhead for your personal use. Please understand you will not receive a copy of the certified testing results sent to us from the lab.  *
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