2026 - Recreation Request Form

2026 - Recreation Request Form

Cuyahoga DD Family Supports Program (FSP)
Cuyahoga DD Family Supports Program's recreation service provides funding to allow individuals to participate in activities of interest in their local community of Cuyahoga County.

*Effective 1/1/2026, Cuyahoga DD will cap spending on recreation at $400 from the participant's total annual budget (allocation).

Please click here to see if the facility you are interested in is listed on our Frequently Requested Vendor Listing
Is the facility/vendor you are interested in located on the Frequently Requested Vendor Listing above?
Individual Receiving FSP Services:
First Name of Child/Individual
Last Name of Child/Individual
Child/Individual Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Name:

First NameLast Name
Parent/Guardian Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail

Confirmation EmailPLEASE ENTER A VALID EMAIL
Telephone Number
Format: (000) 000-0000.
What is the name of the facility you are interested in?
What city is the facility located in?
Facility Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
You may use up to $400 maximum from your 2026 Family Supports Program Allocation for recreation. How much would you like to use?
AMOUNT CANNOT BE GREATER THAN $400
Facility Website link:
Enter the link to the facility (copy and paste) - A website is required to assist with more timely processing. If the facility does not have a website, enter the following: https://neoncog.org/
Facility Address:

Street Address

CityState

Zip Code
Facility Contact Person:

First NameLast Name
Approximate Start Date of Activity (FSP can only pay for services provided on or after the date of enrollment in FSP):

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Approximate End Date of Activity:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please provide details of the membership or activity your are interested in. Include as much detail as possible. For example, dates of lessons, descriptions of the lessons, type of membership, length of membership, etc.:
Signature
Submission Date

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Should be Empty:

2026 - Recreation Request Form

Individual Receiving FSP Services: