Watershed Residential Assistance Program

2. Assistance, Translation Services, Applicant Information
4. Application Assistance

   If you need assistance with this application, need a translator, or would like this application mailed to you, please contact us at cpettit@carrboronc.gov or 919-918-7422.

   Please fill out the form below and click submit. 

6. Do you need translation services?

   1. Yes
   2. No
7. Which language do you need translation services for?
9. First Name*
10. Last Name*
11. Email*
13. Street Address*
14. Mailing Address (if different)
16. City*
17. State*
18. Zip Code*
20. Phone*
21. Type*
    -- Select One --CellHomeWork
25. Stormwater Concerns
27. What property concerns would you like assessed? *

    Select all that apply. 

    1. Flooding and drainage around house
    2. Yard flooding after heavy rains
    3. Persistent wet/poorly drained areas
    4. Managing runoff from rooftop, driveway, etc.
    5. Managing runoff entering or exiting property
    6. Installing a rain garden

    1. Streambank stabilization
    2. Riparian (streamside) improvements
    3. Managing erosion
    4. Rainwater harvesting
    5. Landscaping improvements (e.g., terracing, lawn conversion, soil enhancement, native plantings, invasive plant management)
    6. Other
29. Please provide a brief description of what you would like assessed.
31. Do you own or rent?*

    1. I own my home
    2. I rent my home
32. Is there a stream on your property?

    1. Yes
    2. No
    3. I am unsure
33. Do you have an active land use or building permit application for this property?

    1. Yes
    2. No
    3. I am unsure
37. If you are filling out this application on behalf of someone else, please fill out your information below.
39. First Name
40. Last Name
41. Phone
43. Signature
45. By submitting this application, I affirm that all of the above information is correct to the best of my knowledge. I also understand that this application does not guarantee that I will receive an assessment nor does it obligate the Town or its assignees to any other specific action.
47. Initials*
48. Date*
    Date
52. Demographic Questions

    Note: The following demographic information is completely voluntary but requested to ensure representation from all points of diversity.

54. Which best describes your race?

    Select all that apply. 

    1. American Indian or Alaska Native
    2. Asian or Asian Indian
    3. Black or African American
    4. Native Hawaiian or Pacific Islander
    5. White
    6. Two or more races
    7. Other (Please specify below)
    8. Prefer not to answer
55. Which best describes your ethnicity?

    1. Hispanic or Latino or Spanish Origin
    2. Not Hispanic or Latino or Spanish Origin
    3. Prefer not to answer
57. If you selected 'Other', please specify below.
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

* indicates a required field