Note: If none of the below statements are true for you, you are not eligible for this program.
Verfify address location: Multnomah County Map
* ALTERNATIVE TO A SIGNATURE
If you are unable to electronically sign above, you can follow these steps to acknowledge this information.
1. You will receive an email notification from Jotform. Check your junk folders if you can't find it.
2. If you are unable to sign here, ask your provider for an alternative way to sign.