Upper Susquehanna-Lackawanna Watershed
American Heritage River Project Form

This form can be used to recommend projects for the Upper Susquehanna-Lackawanna Watershed Work Plan.
Print this page and when completed, mail to the address at the bottom.

*These items must be completed to submit a project

Today’s Date: ______________

*Your Name: _______________________________

Your Email Address (if you have one): __________________________

*Project Title: ________________________________

*Project Description:
(Please be as comprehensive as you can in a single paragraph)
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*Classify as: Economic Revitalization [ ], Natural Resource Protection [ ], Historic and Cultural Preservation [ ],
Training and Education [ ] (choose one)

*To your knowledge, is this: a new project [ ], a project for which some planning has been done [ ],
a project for which some progress has been made [ ] (choose one)

It is requested, but not required that these items be completed before submitting a project

Total Project Cost: _____________________________________
(Please give a best estimate if you do not know the actual cost)

Total Funds Committed: _____________________________________
(Please list what private or governmental funds, if any, have been committed for this project)

Potential Funding Sources:
(Please list any private or governmental sources that you are aware of that may be interested funding this project)

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The following information will not be placed on this web-site and will be only be used by representatives of the Upper Susquehanna-Lackawanna Steering Committee

*Your Mailing Address: _____________________________________________

*Your Zip Code: ___________________

*Your Phone Number: ________________________
Mail completed form to:
Tom Williams, Senior Projects Director
Office of Congressman Kanjorski
The Stegmaier Building, Suite 400M
7 North Wilkes-Barre Boulevard
Wilkes-Barre, PA 18702-5283

Questions or Comments: tom.williams@mail.house.gov