Medina County Strong | We Are In This Together

Workforce: Add Your Name to the List is open to all workforce employees in Medina County, Ohio who have lost employment due to the COVID-19 pandemic. Fill out the form to request your name to be added:

One Entry Per Person

Your Full Name: *

Your Email Address: *

Name of Business Where You Work: *

Please provide only ONE business name. If you are self-employed, use your occupation e.g. “musician”

Business Address:

Please provide the business address and zip code. Medina County businesses only. If you are self-employed, use the address you typically use.


Zip Code:

Please Provide a Link to Your Payment Options E.G. Paypal, Venmo, Cash App

Your Paypal.Me Link or Username:

You can make an account at: Do not provide your email address - make a account instead.

Your Venmo Username:

Sign up for an account at Not sure where to find your username?

For Venmo, Provide Last 4 Digits of Your Phone Number:

Venmo sometimes requires someone to verify the last 4 digits of your phone number in order to pay you, if they are not already connected to you on Venmo. You may optionally provide the last 4 digits of your phone number here to help get paid faster.

Your CashApp Username:

You can make an account at: Set up a $Cashtag to share

Terms & Conditions

I confirm that the information I am submitting is truthful and accurate, and I give permission to include my information on the website.

Your privacy is important. Your information will only be used for the intent of the website and will not be used for any other purposes.