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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. Marriage Works! Ohio will review all completed forms and contact applicants regarding their eligibility.

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.
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
Birth Date *
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DD
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Phone Number *
Your answer
Email Address
Your answer
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? *
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