JACKSON-VINTON COMMUNITY ACTION, INC.
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​       Agency Forms & Guidelines     
                        Program Forms & Information                               
                                                  Click on the bullet title  for the information you are seeking:
  • 2025 Federal Poverty Guidelines​
  • Head Start Application 
  • WIC Guidelines
  • REQUIRED DOCUMENTS FOR EMERGENCY PROGRAMS (SCP, WCP, PIPP, HEAP) *NEW
  • CUSTOMER DISPUTE AND APPEALS PROCEDURE 
  • HEAP/CRISIS DOCUMENT OF RESPONSIBILITY (If utility bill is not in your name but you are responsible to pay it) 
  • HEAP/CRISIS EMPLOYMENT VERIFICATION FORM 
  • HEAP & PIPP INCOME GUIDELINES FOR 2023/2024 
  • HEAP/CRISIS- LETTER OF SUPPORT (If someone helps support you)  
  • HEAP- SEASONAL EMPLOYMENT VERIFICATION  
  • HEAP- SELF-DECLARATION OF INCOME FORM   
  • HEAP- SELF-EMPLOYMENT FORM  
  • HEAP- IRS Form 4506-T Request for Transcript of Tax Return  
  • SUMMER CRISIS PROGRAM(SCP) MEDICAL ELIGIBILITY FORM (must have physician statement verifying CHRONIC illness) 
  • Emergency Services and Transportation CSBG Form

Jackson-Vinton Community Action, Inc.
118 S. New York Avenue
Wellston, Ohio 45692

PROVIDING SERVICES TO JACKSON AND VINTON COUNTIES


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Hours

Monday-Friday:
8:00 am - 4:30 pm

Telephone

740-384-3722
1-800-686-4339

  Email              Executive Director

[email protected]          Molly Seimetz
Picture
  • Home
  • Job Postings
  • Information on JVCAI >
    • About
    • JVCAI in Action
    • Contact Us
  • Programs and Services >
    • Head Start Program
    • Jackson County WIC Program
    • Ohio Buckles Buckeyes Carseats
    • Energy Program
    • HEAP and PIPP Plus
    • Community Services Program
    • Transportation Program
    • Mobility Management and Transportation Call Center
  • Forms
  • Links
  • Board Members
  • Surveys >
    • Agency Survey