Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Social Services Donation Form

  1. In March 2012, the Manhattan City Commission passed Resolution 032712-A, authorizing the creation of a utility donation program for social services. As a result, city staff has developed a program to allow residents to make a recurring donation, on monthly utility bills, to help support social service agencies in Manhattan. If you would like to participate, please fill out the form below.

  2. I authorize the City of Manhattan’s Customer Service Department to add the amount listed below to each month’s city utility bill in support of local social service agencies in Manhattan, Kansas. I understand that this donation will continue each month as directed below. Further, I also understand that if my utility bill is delinquent for two (2) consecutive months, my monthly donation will cease immediately.

  3. (Must be in whole dollar amounts and a minimum donation of $1 please)

  4. Please provide a phone number or email to be used in the event that there are any questions regarding your donation.

  5. Leave This Blank:

  6. This field is not part of the form submission.