Skip to Main Content
Do Not Show Again
Mandatory 20 Percent Reduction in Water Use and Restrictions in Effect
COVID-19 Health Orders in Effect
Departments & Services
How Do I...
Select a Category
City Clerk's Office
Commercial Loading Zone Permit
Housing and Community Services
Planning and Economic Development
Recreation & Parks
Santa Rosa Water
Transportation & Public Works
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.
Enroll in Change for Kids
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Round Up to Nearest Dollar
Monthly Fixed Value
If Monthly Fixed Value, How Much?
I hereby agree that by clicking on the "Submit" button I am giving authorization to have my monthly Utility Bill "Rounded" up to the nearest dollar or have the fixed value donation added to my bill each month and that this money will go directly to the Change for Kids Fund for Santa Rosa Kids.
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Emergency & Preparedness Information
Slideshow Left Arrow
Slideshow Right Arrow