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To be considered for selection as a beneficiary of the Tidewater Utilities, Inc. Golf Tournament you must complete the form below and qualify as set forth by the guidelines. If extra space is needed for any answers please attach an extra sheet. Please return this completed application to:Tidewater Utilities, 1100 South Little Creek Road, Dover, DE 19901 ATTN: Joe Cuccinello.

Organization Name: ______Date Submitted: ______

Is the organization a 501.C.3 (YES) ______(NO) ______(Attach proof to completed form)

Quality water service helps support public health and wellness, economic development and quality of life. Tidewater focuses the majority of its charitable efforts on the four areas below which align with its role as a steward of natural resources. Please select the focus area which most closely aligns with yourorganization’s efforts:

____ Environment____ Health and Wellness

____ Education & Leadership Development____ Economic Development/Community Building

Please describe how the funds will be used.

Please describe how your organization supports the focus areas marked above.

What percentage of the donation will actually reach the cause? ______

What area (Counties, Towns, etc…) of Delaware does your organization support?

In what ways would your organization commit to help support the planning and execution of this event? (i.e. providing mailing lists of potential foursomes, event day volunteers,silent auction items, publicity, etc.)

How many people do you think this donation could affect? ______

Organization Contact Person: ______Contact Phone #:______

Contact Person E-mail:______Contact Fax #:______

Tidewater Utilities, Inc. 2016 Charity Golf Tournament

Beneficiary Guidelines

  1. Organization requesting to become a beneficiary of the Tidewater golf tournament must be a 501.C.3 organization and must be able to provide proof with the completed form.
  1. If the organization is selected, the organization must provide Tidewater a W-9.
  1. Organization must have an emphasis in at least one of the following areas:
  1. The Environment
  2. Education & Leadership Development
  3. Health & Wellness
  4. Economic Development/Community Building
  1. Application must be postmarked or hand delivered toTidewater by12/11/2015 to be considered for the 2016 tournament.
  1. If your organization is one of the top 3 organization finalists, a tour/presentation may be required to help The Charity Golf Committee best determine and select the ultimate beneficiary.
  1. The organization that is selected as the beneficiary will be expected to support the outing with a minimum of two foursomes and five silent auction items. A representative will also be invited to offer brief comments at the outing.
  1. If selected, your organization cannot be selected again for another 5 years.

8. The selected beneficiary organization will be notified by Tidewater by mid-February of 2016.

9. Due to the volume of requests we cannot contact all organizations which have applied. If you would like to find outthe results for your organization, you may contact Joe Cuccinello at 302-747-1308.