Applications will ONLY be accepted ... - Athens County, Ohio BTSB Application...
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It’s time to register your children for the 2 nd Annual Athens County Back-to-School Bash! Fill out the attached application and a sizing page for each child in your household that will be in K-12 th grade for the 2020-21 school year. Be sure to print all information legibly and fill out the entire application so the proper items can be ordered. Incomplete applications will be returned. Applications will be accepted on a first-come, first-served basis, contingent upon available funding. Eligible students may receive items such as a school spirit shirt and mask, shorts, a backpack, school supplies, socks, and a new pair of shoes! You will receive a letter, at a later date, that will contain information on how to obtain your back- to-school items. Once you receive this notice, if you need transportation to the location pick up, please call ACDJFS at 740-797-2523. No items will be distributed prior to the event. Applications are available online at jfs.athensoh.org. Printed applications are available through Athens County Department of Job & Family Services, OhioMeansJobs-Athens County, Athens County Children Services, or HAPCAP. Return completed applications to: ACDJFS 13183 SR 13 Millfield, Ohio 45761 Donations for the event are also being accepted at jfs.athensoh.org. Applications will ONLY be accepted between July 23 rd , 2020 – August 10 th , 2020. No late applications will be considered. No walk-in applications will be accepted at the event.
Transcript of Applications will ONLY be accepted ... - Athens County, Ohio BTSB Application...
It’s time to register your children for the 2nd Annual Athens County Back-to-School Bash!
Fill out the attached application and a sizing page for each child in your household that will be in K-12th grade for the 2020-21 school year. Be sure to print all information legibly and fill out the entire application so the proper items can be ordered. Incomplete applications will be returned. Applications will be accepted on a first-come, first-served basis, contingent upon available funding. Eligible students may receive items such as a school spirit shirt and mask, shorts, a backpack, school supplies, socks, and a new pair of shoes!
You will receive a letter, at a later date, that will contain information on how to obtain your back- to-school items. Once you receive this notice, if you need transportation to the location pick up, please call ACDJFS at 740-797-2523. No items will be distributed prior to the event. Applications are available online at jfs.athensoh.org. Printed applications are available through Athens County Department of Job & Family Services, OhioMeansJobs-Athens County, Athens County Children Services, or HAPCAP.
Return completed applications to: ACDJFS 13183 SR 13 Millfield, Ohio 45761
Donations for the event are also being accepted at jfs.athensoh.org.
Applications will ONLY be accepted between July 23rd, 2020 – August 10th, 2020.
No late applications will be considered. No walk-in applications will be accepted at the event.
Complete online or return applications to: Athens County Department of Job and Family Services 13183 State Route 13, Millfield, OH 45761
2nd Annual Back-to-School Bash 2020
List ALL persons residing at this address For school year 2020/2021 In Not in School School
K-12 K-12Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
Name SSN Relationship ________________ DOB
The 2020 Poverty Guidelines
Persons in family 200% Poverty guideline (per month)
1 $2127
2 $2874
3 $3620
4 $4367
5 $5114
6 $5860
7 $6607
8 $7354
For families with more than 8 persons, add $747 for each additional person.
By signing below: • We are residents of Athens County and/or child/children are attending an Athens County school;• We have at least one child that is under the age of 19 and is attending school full time;• No one in my household has an OWF or PRC overpayment due to fraud;• I agree to hold the sponsors harmless from any and all claims, loss or damage to my personal property, liabilities and costs,
including attorney’s fees, as a result of my participation in this event, including travel to and from the event or any eventsincidental to this event;
• I give my permission for my household members to be part of promotional photographs, videos and social media.Signature of Adult Applicant Date: mm/dd/yyyy
Your application will be reviewed by ACDJFS and you will be notified of the outcome. If you feel that your application has not been handled fairly, you may request independent review by contacting Cheryl Hamilton at (740)797-2523. Revised 07/13/2020
Complete one sizing page for each child attending K – 12th in 2020-2021 as attached. Copy if more needed.
Agency Use ONLY Date Received: Time Received: Staff:
Adult Applicant Phone #
Social Security # Other Contact Phone #
Mailing Address City, State, Zip Code
County of Residence This Application must be received by ACDJFS by August 10, 2020 to be considered.
** Please complete the entire application even if
you do not meet the income guidelines!**
(please initial one) • We are under 200% of the
Poverty Guidelines _______;
• We are NOT under 200% of thePoverty Guidelines _______;
(refer to chart to the left)
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Child's Name Age Next Year's Grade
SchoolIF HOME SCHOOLED, STILL SELECT A SCHOOL FOR SHIRT Boy Girl Adult/Applicant's Social Security Number
SHIRT SIZE CHECKMARK ONE SIZE ONLY
CHILD ADULT UNISEX
XS S M L XL
SIZE 4/5 6/8 10/12 14/16 18/20 SIZE S M L XL 2XL 3XL 4XL
CHEST 22-24 25-27 28-30 30-32 32-34 CHEST 35-37 38-40 41-43 44-46 47-49 50-53 54-57
SHORTS SIZEYOUTH
CHECKMARK ONE SIZE ONLY
YOUTH/ADULT
XXS XS S M L S M L XL 2XL 3XL 4XL
WAIST 21-22 22-23 22-24 25-27 28-30 WAIST 28-30 32-34 36-38 40-42 44-46 48-50 52-54
3T-4T 4-5 6-8 10-12 14-16
SOCKS SIZE 4-6 (Ages 4-7) SIZE 6-8 (Ages 8-12) SIZE 9-11(Women) SIZE 10-13 (Men)
SHOE SIZE CHECKMARK ONE SIZE ONLY BOY GIRL
CHECKMARK SIZE ONLY IF YOU WANT REGULAR WIDTH
WIDE WIDTH IS ONLY AVAILABLE IN THE SIZES MARKED…PLEASE CHECKMARK SIZE AND WIDE IF YOU WANT WIDE
Child Not available in Wide
5C 6C 7C 8C 9C 10C 10.5C 11C 11.5C 12C 12.5C 13C 13.5C
BOY GIRL
Youth If you need wide, please checkmark the W below the size otherwise, do not
1Y 1.5Y 2Y 2.5Y 3Y 3.5Y 4Y 4.5Y 5Y 5.5Y 6Y 6.5Y 7YW W W W W W W W W W
Adult Women If you need wide, please checkmark the W below the size otherwise, do not
5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5W W W W W W W W W
Adult Men If you need wide, please checkmark the W below the size otherwise, do not
6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13
W W W W W W W W W W W
13.5 14 14.5 15 15.5 16 16.5 17 17.5 18W W W W W W W W W W
MASK SIZEYouth Size 6"W x 3 3/4"L Adult Size SM/M Adult Size LG/XL
1 CHILD'S INFORMATION PER PAGE - COMPLETE A SEPARATE PAGE FOR EACH CHILD Shirt, Shorts, Socks, Masks and Shoe Sizes for Children entering K-12 Grades
2020-2021 School Year Complete all questions legibly in order to receive back to school supplies for your child(ren)
CHECKMARK ONE SIZE ONLY
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Child's Name Age Next Year's Grade
SchoolIF HOME SCHOOLED, STILL SELECT A SCHOOL FOR SHIRT Boy Girl Adult/Applicant's Social Security Number
SHIRT SIZE CHECKMARK ONE SIZE ONLY
CHILD ADULT UNISEX
XS S M L XL
SIZE 4/5 6/8 10/12 14/16 18/20 SIZE S M L XL 2XL 3XL 4XL
CHEST 22-24 25-27 28-30 30-32 32-34 CHEST 35-37 38-40 41-43 44-46 47-49 50-53 54-57
SHORTS SIZEYOUTH
CHECKMARK ONE SIZE ONLY
YOUTH/ADULT
XXS XS S M L S M L XL 2XL 3XL 4XL
WAIST 21-22 22-23 22-24 25-27 28-30 WAIST 28-30 32-34 36-38 40-42 44-46 48-50 52-54
3T-4T 4-5 6-8 10-12 14-16
SOCKS SIZE 4-6 (Ages 4-7) SIZE 6-8 (Ages 8-12) SIZE 9-11(Women) SIZE 10-13 (Men)
SHOE SIZE CHECKMARK ONE SIZE ONLY BOY GIRL
CHECKMARK SIZE ONLY IF YOU WANT REGULAR WIDTH
WIDE WIDTH IS ONLY AVAILABLE IN THE SIZES MARKED…PLEASE CHECKMARK SIZE AND WIDE IF YOU WANT WIDE
Child Not available in Wide
5C 6C 7C 8C 9C 10C 10.5C 11C 11.5C 12C 12.5C 13C 13.5C
BOY GIRL
Youth If you need wide, please checkmark the W below the size otherwise, do not
1Y 1.5Y 2Y 2.5Y 3Y 3.5Y 4Y 4.5Y 5Y 5.5Y 6Y 6.5Y 7YW W W W W W W W W W
Adult Women If you need wide, please checkmark the W below the size otherwise, do not
5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5W W W W W W W W W
Adult Men If you need wide, please checkmark the W below the size otherwise, do not
6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13
W W W W W W W W W W W
13.5 14 14.5 15 15.5 16 16.5 17 17.5 18W W W W W W W W W W
MASK SIZEYouth Size 6"W x 3 3/4"L Adult Size SM/M Adult Size LG/XL
1 CHILD'S INFORMATION PER PAGE - COMPLETE A SEPARATE PAGE FOR EACH CHILD Shirt, Shorts, Socks, Masks and Shoe Sizes for Children entering K-12 Grades
2020-2021 School Year Complete all questions legibly in order to receive back to school supplies for your child(ren)
CHECKMARK ONE SIZE ONLY
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Child's Name Age Next Year's Grade
SchoolIF HOME SCHOOLED, STILL SELECT A SCHOOL FOR SHIRT Boy Girl Adult/Applicant's Social Security Number
SHIRT SIZE CHECKMARK ONE SIZE ONLY
CHILD ADULT UNISEX
XS S M L XL
SIZE 4/5 6/8 10/12 14/16 18/20 SIZE S M L XL 2XL 3XL 4XL
CHEST 22-24 25-27 28-30 30-32 32-34 CHEST 35-37 38-40 41-43 44-46 47-49 50-53 54-57
SHORTS SIZEYOUTH
CHECKMARK ONE SIZE ONLY
YOUTH/ADULT
XXS XS S M L S M L XL 2XL 3XL 4XL
WAIST 21-22 22-23 22-24 25-27 28-30 WAIST 28-30 32-34 36-38 40-42 44-46 48-50 52-54
3T-4T 4-5 6-8 10-12 14-16
SOCKS SIZE 4-6 (Ages 4-7) SIZE 6-8 (Ages 8-12) SIZE 9-11(Women) SIZE 10-13 (Men)
SHOE SIZE CHECKMARK ONE SIZE ONLY BOY GIRL
CHECKMARK SIZE ONLY IF YOU WANT REGULAR WIDTH
WIDE WIDTH IS ONLY AVAILABLE IN THE SIZES MARKED…PLEASE CHECKMARK SIZE AND WIDE IF YOU WANT WIDE
Child Not available in Wide
5C 6C 7C 8C 9C 10C 10.5C 11C 11.5C 12C 12.5C 13C 13.5C
BOY GIRL
Youth If you need wide, please checkmark the W below the size otherwise, do not
1Y 1.5Y 2Y 2.5Y 3Y 3.5Y 4Y 4.5Y 5Y 5.5Y 6Y 6.5Y 7YW W W W W W W W W W
Adult Women If you need wide, please checkmark the W below the size otherwise, do not
5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5W W W W W W W W W
Adult Men If you need wide, please checkmark the W below the size otherwise, do not
6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13
W W W W W W W W W W W
13.5 14 14.5 15 15.5 16 16.5 17 17.5 18W W W W W W W W W W
MASK SIZEYouth Size 6"W x 3 3/4"L Adult Size SM/M Adult Size LG/XL
1 CHILD'S INFORMATION PER PAGE - COMPLETE A SEPARATE PAGE FOR EACH CHILD Shirt, Shorts, Socks, Masks and Shoe Sizes for Children entering K-12 Grades
2020-2021 School Year Complete all questions legibly in order to receive back to school supplies for your child(ren)
CHECKMARK ONE SIZE ONLY
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Child's Name Age Next Year's Grade
SchoolIF HOME SCHOOLED, STILL SELECT A SCHOOL FOR SHIRT Boy Girl Adult/Applicant's Social Security Number
SHIRT SIZE CHECKMARK ONE SIZE ONLY
CHILD ADULT UNISEX
XS S M L XL
SIZE 4/5 6/8 10/12 14/16 18/20 SIZE S M L XL 2XL 3XL 4XL
CHEST 22-24 25-27 28-30 30-32 32-34 CHEST 35-37 38-40 41-43 44-46 47-49 50-53 54-57
SHORTS SIZEYOUTH
CHECKMARK ONE SIZE ONLY
YOUTH/ADULT
XXS XS S M L S M L XL 2XL 3XL 4XL
WAIST 21-22 22-23 22-24 25-27 28-30 WAIST 28-30 32-34 36-38 40-42 44-46 48-50 52-54
3T-4T 4-5 6-8 10-12 14-16
SOCKS SIZE 4-6 (Ages 4-7) SIZE 6-8 (Ages 8-12) SIZE 9-11(Women) SIZE 10-13 (Men)
SHOE SIZE CHECKMARK ONE SIZE ONLY BOY GIRL
CHECKMARK SIZE ONLY IF YOU WANT REGULAR WIDTH
WIDE WIDTH IS ONLY AVAILABLE IN THE SIZES MARKED…PLEASE CHECKMARK SIZE AND WIDE IF YOU WANT WIDE
Child Not available in Wide
5C 6C 7C 8C 9C 10C 10.5C 11C 11.5C 12C 12.5C 13C 13.5C
BOY GIRL
Youth If you need wide, please checkmark the W below the size otherwise, do not
1Y 1.5Y 2Y 2.5Y 3Y 3.5Y 4Y 4.5Y 5Y 5.5Y 6Y 6.5Y 7YW W W W W W W W W W
Adult Women If you need wide, please checkmark the W below the size otherwise, do not
5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5W W W W W W W W W
Adult Men If you need wide, please checkmark the W below the size otherwise, do not
6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13
W W W W W W W W W W W
13.5 14 14.5 15 15.5 16 16.5 17 17.5 18W W W W W W W W W W
MASK SIZEYouth Size 6"W x 3 3/4"L Adult Size SM/M Adult Size LG/XL
1 CHILD'S INFORMATION PER PAGE - COMPLETE A SEPARATE PAGE FOR EACH CHILD Shirt, Shorts, Socks, Masks and Shoe Sizes for Children entering K-12 Grades
2020-2021 School Year Complete all questions legibly in order to receive back to school supplies for your child(ren)
CHECKMARK ONE SIZE ONLY
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