Skip to Main Content
Do Not Show Again
I Want To…
You Are Here:
Select a Category
City Clerk Forms
City Manager Forms
Contact Us - Fire
Licenses & Permits
Newsletters and Notifications
Parks and Recreation
Social Services Advisory Board
Special Alcohol Fund Advisory Board
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.
Sign in to Save Progress
Social Services Donation Form
This form has been modified since it was saved. Please review all fields before submitting.
About Social Services Donation
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.
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.
Water Account Number (without dashes):
What amount would you like to be added to your monthly utility bill for donation to Social Services in Manhattan?
(Must be in whole dollar amounts and a minimum donation of $1 please)
Please choose one of the following.
This monthly donation continues until I no longer require water service at the address noted below.
This monthly donation shall end on the date listed below.
Please provide a phone number or email to be used in the event that there are any questions regarding your donation.
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
Submit and Print
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow