Low Income Rebate Application
Please fill out the following form with as much detail as you can. Fields highlighted in RED are required. Call the Aurora Water Conservation Department at 303-739-7195 with questions or comments.
Customer Information

No Yes








Home Location





Household Information



List everyone living the the home other than the head of household (adults and minors)

Relation First Name Last Name Age
Income Sources

Check all that apply

Water Fixtures


Affidavit of Lawful Presence in the USA Required for Aurora Water's Rebate Application. Under House Bill 06S-1023, anyone 18 years or older must prove lawful presence in the United States to receive public benefits.

I swear or affirm, under penalty of perjury under the State of Colorado, that

(check one)
I am a US Citizen
I am not a US Citizen, but I am a Permanent Resident of the US
I am not a US Citizen, but I am lawfully present in the US
I am a foreign national not physically present in the US

Applicants must provide valid identification. Acceptable forms of ID are:
  • Valid State Driver's license or State identification card
  • US Passport
  • U.S. Military card or military dependents identification card
  • U.S. Coast Guard Merchant Mariner card
  • Native American Tribal Document
Submit

Once the application is completed and submitted you will receive an automated email with a link to upload necessary documents