Sedgwick County
Conservation District
11832 West Central, Ste 100
Wichita, KS 67212
Phone: 316-721-6127 ext. 7970
Email: [email protected]
FY2_ State Cost Share NPS-OSW Financial Assistance Request
Please complete for cost-share financial assistance consideration
Replacement system estimated completion date: Legal Description/Address where system will be installed: Multiple landowners (please circle)? Yes No
(If yes, please see back page.)
Landowner Name(s) (as appearing on deed):
Mailing Address:
Phone (cell/home): Email: Other Contact Name: Address: Phone (cell/home): Email:
NOTE:
Completing this form does not guarantee cost-share financial assistance.
Construction/installation/implementation of this practice or any part thereof started prior to contract ap-proval will result in ineligibility for cost-share financial assistance.
Each proposed project will be evaluated and ranked by Sedgwick County Conservation District based on established criteria.
If approved for financial assistance, the landowner must sign a contract agreeing to the terms set forth in the contract before construction may begin. Certain projects have additional requirements.
You will be notified of the status of your request for cost-share financial assistance by Sedgwick County Conservation District.
An on-site evaluation of the completed project shall be conducted and a Notice of Completion shall be on file with Sedgwick County Conservation District before final payment is issued from the State of Kansas.
Funding for state cost-share programs is provided by the Division of Conservation, Kansas Department of Agriculture through appropriation from the Kansas Water Plan Fund.
Multiple Landowners:
Additional Landowner Name (as appearing on deed):
Mailing Address:
Phone (cell/home): Email:
Percent Share:
Additional Landowner Name (as appearing on deed):
Mailing Address:
Phone (cell/home): Email:
Percent Share:
Additional Landowner Name (as appearing on deed):
Mailing Address:
Phone (cell/home): Email:
Percent Share:
Revised: 2-6-2025
