New Jersey Rain Garden Rebate Program Application 
Complete this form, attach a post‐installation photo, and mail to: Rutgers Water Resources Program, ATTN: Sara Mellor 14 College Farm Road, New Brunswick, NJ 08901 Or e‐mail this document and your photo to saramellor@envsci.rutgers.edu 
Name (of person receiving rebate): ___________________________________________________ 
Installation Address: _______________________________________________________________ 
City:  Somerville Bridgewater Raritan  Hillsborough  Zip Code: __________________ 
Mailing Address (if different): ________________________________________________________ 
City: _____________________________________ State: _______ Zip Code: ________________ 
Phone: _________________________________ 
Email address: ____________________________________________________________________ 
Square footage of rain garden installed: __________ 
Prior to installation, where did the roof leader(s) drain? 
 Driveway  Lawn or landscaping  Piped to street  Do not know or N/A 

Rutgers will contact you regarding an installation inspection and photo documentation. 
      I authorize Rutgers/NJWSA to inspect my rain garden in my absence with prior notification                                     of date and time.
I will be present during an agreed upon inspection date and time. 

How much did the rebate influence your decision to install a rain garden? 
    Completely     Somewhat   Not at all 

How much did the design support influence your decision to install a rain garden?
Completely     Somewhat   Not at all 

What was your primary reason for installing a rain garden? 
To reduce stormwater runoff     To direct water away from my house
    To increase groundwater recharge To be environmentally friendly
    To increase the beauty of my yard Other: ________________________

How did you hear about this program? 
Flyer Newspaper Internet Municipality/County      Retail store:_______________ Other: _____________________________

I pledge the information I have provided is accurate and I will maintain my rain garden for at least 5 years. 

Signature ____________________________________________________ Date _______________ 
If you have any questions, please contact Rutgers Water Resources Program at 848‐932‐6747.

Rutgers Water Resources Program administers the New Jersey Rain Garden Rebate Program with a grant funded by the New Jersey Water Supply Authority.