Declaration Regarding Material Assistance/Non-Assistance to a Terrorist Organization (DMA)
Print a hard copy of the form once it has been downloaded. The form must be completed in its entirety and your responses must be truthful to the best of your knowledge. A reference copy of the Terrorist Exclusion List has been provided in PDF format below. Submit the DMA form along with your application.

Completed DMA forms are NOT to be sent to Ohio Homeland Security. They are to be submitted to and retained by the issuing agency or entity.

DMA for licensure PDF Word
DMA for public employment
DMA for funding and business contracts  PDF Word

Request form for the denial of licensure
Request form for the denial of public employment
Request form for the denial of funding or business contract
Request form for the denial of pre-certification