This item is Mandatory, please upload a scan or picture of the document
This item is Mandatory, please upload a scan or picture of the document. In most cases this is a bill from the household in the parent/guardian's name.
This item is Mandatory only for youth ages 14-17, please upload a scan or picture of the document
This item is Mandatory, please upload a scan or picture of the document. This is for the 2019/2020 school year
This item is Mandatory, please upload a scan or picture of the document. This is normally for the parent/guardian of the household. Only 1 proof of income is needed.
Example: Rachel (Do not use all caps)
Example: Smith (Do not use all caps)
Example: 31 Spooner St.
Only use if applicable, leave blank if not
***This program is for City of Buffalo residents ONLY***
Please select from the drop down choices
If Other, please put where you where born in the next box
Example on the Middle Left of your card: 335-049. DO NOT USE THE AT-18 AT THE TOP OF THE CARD
Please select from drop down, if Other or Immigrant/Refugee proceed to the next box
Please select from the drop down
Select the range from the drop down selections. (Income includes any public assistance you may receive)
As of 3/31/20
Examples: School #81 or Burgard High School, or Niagara University. Use the Full Name of your school/program
Example: John Smith
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Use this box if you know what site is requesting you for this coming summer. ***THIS DOES NOT GUARANTEE PLACEMENT***
This field is not part of the form submission.
* indicates a required field