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This section determines eligibility for the WIOA program.
If you are not attending high school or college/technical school, skip this question.
(Provide hourly or weekly wages)
- Local elected official (mayor or county commissioner)
- Workforce Development Board member or subcommittee member
-WIOA executive, supervisor, or employee
-OhioMeansJobs center employee, partner employee, WIOA sub-recipient and/or contracted worker
- CDJFS or other county employee
This section determines initial and ongoing eligibility for TANF-funded services.
200% of Federal Poverty Guidelines (2019)
- a minor child
- a parent, specified relative, legal guardian, or legal custodian of a minor child
- a pregnant individual
- an individual age 18-24 that is part of a family that includes a minor child
By signing, I attest that the information stated above is true and accurate. I understand that if the information or income provided was misrepresented, it may be ground for immediate termination in the CCMEP program and/or penalties as specified by law. If the applicant is under the age of 18, the parent/guardian signature below gives permission for the youth to participate in CCMEP services and activities.
If applicant is under age 18
This field is not part of the form submission.
* indicates a required field