Please attach information requested regarding the Utility Billing Assistance Program with the City of Modesto.

Fields with an "*" are required entries. Please enter the information in the following fields and attached the information requested in the previous email to complete your application for the Utility Billing Assistance Program. 1) Name* 2) Service Address* 3) Email Address* Provide documentation from at least one of the public assistance programs to confirm proof of benefits. PLEASE NOTE: WE CANNOT ACCEPT BENEFIT CARDS AS PROOF. CalWorks CalFresh General Assistance Benefits Medi-Cal California Special Supplemental Nutrition Program for Women, Infants and Children (WIC) State Supplementary Payments (SSP) Supplemental Security Income (SSI) CARE Discount - MID, TID or PG&E 4) Attachments* Drop files here, or browse to attach files Cancel All Confirmation Required Are you sure you want to remove the selected file? ConfirmCancel 5) Comment Thank you contacting the City of Modesto regarding your Utility Billing Assistance Program request. Click on Submit at the top of this form. An email will be sent to acknowledge this request.