United Way of Putnam County Back To School Assistance Program

United Way of Putnam County Back To School Assistance Program

Submitting this form does not guarantee acceptance. All eligible Putnam County, Ohio families will receive an official event invitation by mail with full event details and confirmation of acceptance. Please ensure your mailing address is accurate.
Parent/Guardian Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How many children are you applying for?*
Student Information*
Do you receive any of the following (Check all that apply)*

Free or Reduced-Price School Lunch ProgramTANF (Temporary Assistance for Needy Families)MedicaidWIC (Women, Infants, and Children)SNAP (Supplemental Nutrition Assistance Program)
Please submit proof of program eligibility

Cancelof
Please describe any special circumstances or additional information we should consider:
Are you interested in seeing if you are eligible for a clothing voucher?
By checking this box, you certify that all information provided is true and accurate. This information will be used to determine program eligibility.
Should be Empty: