INFORMATION ABOUT THE OTHER PARENT THIS OTHER PARENT IS THE MOTHER FATHER/ALLEGED FATHER OF OTHER PARENT REFERS TO THE NON-APPLICANT PARENT OF THE CHILD(REN) OR IN THE CASE OF A CARETAKER APPLICANT, IT REFERS TO BOTH THE MOTHER AND FATHER OF THE CHILD(REN) AND AN INFORMATION SHEET FOR EACH PARENT IS NEEDED. *IF THERE ARE MORE THAN 2 OTHER PARENTS, PLEASE MAKE COPIES AS NEEDED TO PROVIDE INFORMATION FOR EACH ADDITIONAL OTHER PARENT.* IS THERE A HISTORY OF DOMESTIC VIOLENCE WITH THIS DOCUMENTATION OR A FIRST MIDDLE MAIDEN OR OTHER BIRTH (CITY & STATE) GENDER DOES OTHER PARENT NEED AN INTERPRETER? OR ADDRESS-STREET CITY STATE ZIP RESIDENTIAL OR OTHER CITY STATE ZIP MARITAL STATUS & IF PARENT NAMES OF IN PARENT’S OF HOME PHONE WORK PHONE CELL PHONE OTHER PHONE HAS BANK ACCOUNT AT? EMAIL ADDRESS EYE COLOR HAIR COLOR HEIGHT (FT, IN) WEIGHT OTHER IDENTIFYING MARKS/FEATURES PARENT LIVED IN OHIO? YES NO HAS OTHER PARENT EVER WITH THE CHILD? YES NO HAS OTHER EVER RECEIVED: SOCIAL SECURITY UNEMPLOYMENT WORKER’S COMPENSATION PUBLIC ASSISTANCE VETERAN’S BENEFITS OTHER ___________________________________________ SERVICE: YES NO THE OTHER A YES NO BRANCH ____________________________________ STATION ___________________________________ DATES: FROM __________ TO ___________ IS OTHER PARENT A STUDENT YES, WHERE GRADE LEVEL & : ARREST/PRISON RECORD YES NO IF YES, WHERE DATE: RELEASE DATE: LIST ANY PROFESSIONAL OR RECREATIONAL CAR MODEL/MAKE/YEAR NAME OTHER PARENT’S FATHER NAME OTHER MOTHER HIS ADDRESS HER ADDRESS FATHER’S PHONE MOTHER’S PHONE INFORMATION ABOUT OTHER PARENT’S EMPLOYMENT CURRENT EMPLOYER ADDRESS-STREET CITY STATE ZIP IF UNEMPLOYED, NAME LAST EMPLOYER ADDRESS-STREET CITY STATE ZIP OCCUPATION NAME LOCAL NO. ADDITIONAL INFORMATION THAT COULD ASSIST IN LOCATION OF OF OF
INFORMATION ABOUT THE OTHER PARENT THIS OTHER PARENT IS THE MOTHER FATHER/ALLEGED FATHER OTHER PARENT REFERS TO THE NON-APPLICANT PARENT OF THE CHILD(REN) OR IN THE CASE OF A CARETAKER APPLICANT, IT REFERS TO BOTH THE MOTHER AND FATHER OF THE CHILD(REN) AND AN INFORMATION SHEET FOR EACH PARENT IS NEEDED. *IF THERE ARE MORE THAN 2 OTHER PARENTS, PLEASE MAKE COPIES AS NEEDED TO PROVIDE INFORMATION FOR EACH ADDITIONAL OTHER PARENT.* IS THERE A HISTORY OF DOMESTIC VIOLENCE WITH THIS FIRST MIDDLE MAIDEN OR OTHER OF BIRTH (CITY & STATE) GENDER DOES OTHER PARENT NEED AN INTERPRETER? CITY STATE ZIP RESIDENTIAL OR OTHER ADDRESS-STREET CITY STATE ZIP MARITAL STATUS & NAMES HOME PHONE WORK PHONE CELL PHONE OTHER PHONE HAS BANK ACCOUNT AT? EMAIL ADDRESS EYE COLOR HAIR COLOR HEIGHT (FT, IN) WEIGHT OTHER IDENTIFYING MARKS/FEATURES OHIO? YES NO HAS OTHER PARENT EVER LIVED WITH THE CHILD? YES NO HAS OTHER PARENT EVER RECEIVED: SOCIAL SECURITY UNEMPLOYMENT WORKER’S COMPENSATION PUBLIC ASSISTANCE VETERAN’S BENEFITS OTHER ___________________________________________ SERVICE: YES NO THE OTHER PARENT A YES NO BRANCH ____________________________________ STATION ___________________________________ DATES: FROM __________ TO ___________ IS OTHER PARENT A STUDENT IF YES, WHERE GRADE LEVEL & : ARREST/PRISON RECORD YES NO IF YES, WHERE DATE: RELEASE DATE: LIST ANY PROFESSIONAL OR RECREATIONAL CAR MODEL/MAKE/YEAR NAME OF OTHER PARENT’S FATHER NAME OF OTHER PARENT’S MOTHER HIS ADDRESS HER ADDRESS FATHER’S PHONE MOTHER’S PHONE INFORMATION ABOUT OTHER PARENT’S EMPLOYMENT CURRENT EMPLOYER ADDRESS-STREET CITY STATE ZIP IF UNEMPLOYED, NAME LAST EMPLOYER ADDRESS-STREET CITY STATE ZIP OCCUPATION NAME LOCAL NO. ADDITIONAL INFORMATION THAT COULD ASSIST IN LOCATION OF IN OF OF A OR IN OR DOCUMENTATION