PRC Disaster Application

Fill in this application on screen or print it blank, then sign it and return it to Meigs County Job and Family Services.

How to use this form

Type your answers, then choose Print application. For your security, Social Security numbers, your initials, signature and date are not typed online. Write them in ink on the printed copy. Every field has a label for screen readers, and you can move between fields with the Tab key. Nothing you type is sent over the internet or saved. If you need help completing the application or need it in another format, call 740-992-2117 (TTY users dial 711).

Return your completed, signed application to:
Meigs County Job and Family Services · 175 Race Street, Middleport, Ohio
Deadline to Apply: November 20, 2026 or until all allocated funds have been used. Questions? Call 740-992-2117

Voter registration application attached – assistance available

If you are not registered to vote where you live now, would you like to apply to register to vote here today?

YES, I want to register to voteNO, I do not want to register to vote

If you do not check either box, you will be considered to have decided not to register to vote at this time. Open the Voter Registration form (PDF) (PDF on the Ohio Secretary of State website, opens in a new tab – you are leaving the Meigs County JFS website)

Applicant

Name of applicant

Social Security NumberWrite by hand after printing

Phone number where you can be reached Affected address (damaged by the flooding) Current mailing address

Flood damage

YesNo

Household members

List all members living in your home, including yourself.

Social Security numbers are written by hand on the printed copy.

Person	Name	Relationship to applicant	Age	Social Security NumberHandwrite	Current grade in school	Employer’s name or school	Monthly amount of income
1. SELF				Self: Social Security Number: write by hand after printing
2.				Person 2: Social Security Number: write by hand after printing
3.				Person 3: Social Security Number: write by hand after printing
4.				Person 4: Social Security Number: write by hand after printing
5.				Person 5: Social Security Number: write by hand after printing
6.				Person 6: Social Security Number: write by hand after printing

On a phone, swipe the table sideways to see every column.

Income

The 2026 Poverty Guidelines
Persons in family	200% Poverty guideline (per month)
1	$2660
2	$3607
3	$4554
4	$5500
5	$6447
6	$7394
7	$8340
8	$9287

I attest that my household is at or below guidelines (initial)Write by hand after printing

Age and disability

YesNo

Do you receive:

YesNo

**Disability Verification is Required**

Signature

By my signature below, I affirm that to the best of my knowledge and belief the answers on this application are complete and correct. I understand that the law provides a penalty of fine and imprisonment (or both) for anyone convicted of accepting assistance he or she is not eligible for. I state under penalty of perjury that all the information on this PRC application is true and complete to the best of my knowledge.

Signature of applicantWrite by hand after printing

DateWrite by hand after printing

Sign and date in ink after printing. A typed name is not accepted as a signature.

Download PDF version Voter Registration

Your answers stay in this browser window only. Close the window after printing if you are on a shared or public computer.

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