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ODJFS TANF Non-Assistance Eligibility Form
Filling out this form does not automatically qualify the applicant for state-subsidized services. Instead, Marriage Works! Ohio will review the applicant's completed form and contact them regarding their eligibility.

If the applicant is 18 or younger and in high school, this form must be completed by a parent/guardian.
Today's Date *
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First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Birth Date *
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What program or class are you interested in? *
Which is the best way for you to be contacted? *
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