/

/

Yes

No

(

)

-

(

)

-

*

*

*

*

*

*

*

(

)

-

(

)

-

(

)

-

-

-

Male

Female

Yes

No

Yes

No

/

/

/

/

-

-

Male

Female

Yes

No

Yes

No

/

/

/

/

-

-

Male

Female

Yes

No

Yes

No

/

/

/

/

-

-

Male

Female

Yes

No

Yes

No

/

/

/

/

Yes

*

No

*

Active Duty

National Guard/Reserve

No

*

Yes

*

/

/

No

*

Yes

*

Attach extra names of people in household here.

Uploading...

You can upload one or more files.

No

*

Yes

*

No

*

Yes

*

No

*

Yes

*

I am not sure

*

*

No

*

Yes

*

/

/

/

/

/

/

/

/

Yes

No

Draw Type Upload

Choose your signature image

*

*

*

/

*

/

*

/

/

/

/

-

-

-

-

Yes

No

AM

PM

Full Day

-

-

Yes

No

-

-

AM

PM

Full Day

Attach caretaker employment, school, or training proof here.

Uploading...

You can upload one or more files.

Attach household resources proof here.

Uploading...

You can upload one or more files.

Attach household income proof here.

Uploading...

You can upload one or more files.

Registering as an Ohio Voter

Updating my address

Updating my name

Yes

No

Yes

No

/

/

(

)

-

Draw Type Upload

Choose your signature image

*

/

*

/

*

Draw Type Upload

Choose your signature image

Attach household expenses proof here.

Uploading...

You can upload one or more files.

Page 1

Page 2

Page 3

Page 4

Page 5

Page 6

Page 7

Page 8

Page 9

Page 10

 Page /  

  

Your form has been saved. You can complete it via this link within 60 days.

To make PlatoForms shining, please run with modern browser

You are using an outdated version of IE browser, please upgrade
to any of the following web browsers to access this website.

Note: This check is only for our form builder. Your published form will be compatible with all major browsers.

Chrome
Firefox
Opera
Safari
Microsoft Edge

Sorry for the inconvenience!