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Financial Assistance "Leisure Bucks" Request

Steps

  1. 1. Applicant Information
  2. 2. Type of Application
  3. 3. Validation
  • Applicant Information

    1. Title II Compliance

      In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit https://www.modestogov.com/865/Americans-with-Disabilities-Act-ADA.

    2. First name of applicant, or the guardian or parent of applicant if the applicant is a youth.

    3. Last name of applicant, or the guardian or parent of applicant if the applicant is a youth.

    4. If you have a spouse, is their last name the same as yours?

    5. Email address of applicant, or their guardian or parent.

    6. Is the above address your mailing address?

    7. Is this a renewal application?