Application Forms and Additional Resources

Application submittal information:


Please read ALL of the three links below:

***April 15, 2020 ASADRA Funding Application Deadline Update   

***March 24, 2020 Special Instructions for Spring 2020 SRF and ASADRA Applications:

***April 6, 2020 UPDATED Special Instructions for Spring 2020 SRF and ASADRA Applications

  • Physical Address: For Fed Ex and UPS, please use the physical address, as having applications delivered to the mailing address will delay delivery.
                  Division of Water Infrastructure-8th floor
                  Archdale Building
                  512 North Salisbury Street
                  Raleigh, NC 27604
  • Mailing Address: When using the mailing address, please allow ample time for delivery, as the Division of Water Infrastructure cannot assure timely delivery using this method.
                  Division of Water Infrastructure
                  1633 Mail Service Center
                  Raleigh, NC 27699-1633



Important Information:

  • The tabs below include all of the application forms for each program. 
  • Complete all forms in the Common Forms tab for every program.
  • For each program, complete the Priority Points Rating Sheet for that program only following the appropriate guidance.
  • The CDBG-I Program will have additional forms that must be completed as noted.
  • Additional resources to use while completing applications are found in the last tab.
  • Contact us if you need assistance preparing your application.

Application Training:

***Please Note: The rescheduled date for the Pembroke Application Training is Friday, March 13, starting at 9:30 a.m. For those already registered for the original date, your space is still guaranteed, and you can send a proxy in your place.

2020 Spring Funding Application Training Documents, Handouts and PowerPoint presentation:


Spring 2020 Training Agenda

Spring Training 2020 Evaluation Form

Spring 2020 Division Application

Spring 2020 Financial Information

Spring 2020 Fund Transfer Certification Form


Common Forms Priority Points Rating Sheet and Guidance

Priority Points Rating Sheet and Guidance

CWSRF, DWSRF, State Project Grants (WW), State Project Grants (DW)

Combined Priority Rating System Guidance and Form for Construction Projects Updated 2/12/20


Asset Inventory and Assessment Grant Guidance and Form  Updated 7/18/18


Merger Regionalization Study Grant Priority Rating System Guidance and Form Updated 7/18/18


CDBG-I Priority Rating System Guidance Updated 6/1/20

CDBG-I Priority Rating System Interactive Scorecard Updated 6/1/20

Appendix A Determining LMI Percentages Updated 6/1/20

Appendix B Public Hearings Updated 6/1/20

Appendix C IDIS Form Instructions Updated 5/10/19

CDBG-I Additional Forms

CDBG-I Additional Forms


Resolution Updated 3/20/17 


Interactive Scorecard Updated 8/6/19

Commitment of Other Funds Updated 3/20/17 


Income Survey Questionnaire  Updated 5/10/19

Income Survey Questionnaire (Spanish) Updated 5/10/19

Income Survey Questionnaire Instructions Updated 3/20/17

Income Survey Questionnaire Instructions (Spanish) Updated 3/20/17

Income Survey Sample (1) Updated 3/20/17

Income Survey Sample (2) Updated 3/20/17

Income Survey Summary Updated 8/30/17

2019 Income Limits Updated 6/24/19

2020 Income Limits Updated 6/1/20


CIP Guidance

Asset Management Plan Guidance Updated 2/22/17

Water & Sewer Rate Form Updated 3/20/17

Financial Information Form Updated 8/28/19


Public Hearing Checklist 

Public Notice for Hearing Updated 5/10/19

Public Notice for Hearing - Spanish Updated 5/10/19

Public Hearing Script Updated 6/1/20

Public Hearing Minutes Template Updated 6/1/20

Certification of Understanding Roles and Responsibilities Updated 3/20/17

Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Conflict of Interest Disclosure Updated 3/20/17

Federal Performance and Procurement Requirements Certification Updated 3/20/17

Disclosure Report Updated 3/20/17

Infrastructure National Objective Form 


Additional Resources

Additional Resources

2017 Local Government Unit Parameters - Places* Updated 2/26/19 

2017 Local Government Unit Parameters - Counties* Updated 2/26/19

Affordability Calculator Updated 2/26/19

Supplemental Guidance for Bulk Connections

Documenting Low Pressure

  *Datasets include poverty rates and median household income