Bridges and Street Outreach Contact Form

Please fill out this contact form and a housing or outreach specialist will contact you. You can also call 402-437-8850 to speak with a housing or outreach specialist. 

Alternatively, this form may be downloaded to be completed and returned to:

CEDARS 
Attn:  Admissions (Bridges/TLP)
6601 Pioneers Blvd., Suite 1
Lincoln, NE 68506
Fax: (402) 437-8833

About Yourself:
/
/
Gender
Sexual Orientation

*CEDARS does not discriminate based on gender identity or sexual orientation.

Where are you living right now?
(Street/P.O. Box)
(including area code)
Tell us about your current living situation:
(bed, couch, floor)
Have you ever experienced homelessness on the streets or in an Emergency Shelter in the past three years?
Have you ever been in any other Transitional Living Program?
Education:
Family Information:
(including area code)
(including area code)
Emergency Contact Information:
(Name)
Your Health:

In order for CEDARS to better understand what you have been through, please answer the following questions honestly:

Are you pregnant or parenting?
(Females only)
If pregnant, are you getting prenatal care?
If Parenting, Please List Child(ren)'s Information:
Child 1's Gender
Is other parent involved?

Please list emergency contact names and phone numbers. If you have (a) child/ren, list the child/ren’s other parent and/or a relative of the child/ren as an emergency contact.

Child 2's Gender
Is other parent involved?
Child 3's Gender
Is other parent involved?
Child 4's Gender
Is other parent involved?
Legal:
Are you currently on probation?
(If no, type N/A)
(If no Probation Officer, type N/A)
(If no Probation Officer, type N/A)
Have you ever been a ward of the state?
(If no, type N/A)
Independent Living Skills:
Are you currently employed?
Do you currently receive assistance?
Check all that apply:
Transportation:
Do you currently have a driver's license?
Do you have a car?

If you have questions or need assistance, please call 402-437-8850.