Request edit access
ODJFS TANF Non-Assistance Eligibility Form
Filling out this form does not automatically qualify the applicant for state-subsidized services. The applicant has to meet the financial requirements and have at least one minor child. The Elizabeth's New Life Center (ENLC) will review all completed forms and contact applicants regarding their eligibility. All information is kept strictly confidential by ENLC.

If the applicant is 18 or younger and in high school, this form must be completed by a parent/guardian. If the applicant plans on attending class with a partner (spouse, significant other, i.e.), both parties must fill out a form.
Untitled Title
03/11/2021 *
Column 1
Row 1
Clear selection
First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Birth Date *
MM
/
DD
/
YYYY
Phone Number *
Email Address
How may we contact you? (Check all that apply) *
Required
Would you like to be added to our email list to receive occasional updates on our classes and events? *
What program or class are you interested in? *
Next
Never submit passwords through Google Forms.
This form was created inside of Elizabeth's New Life Center. Report Abuse