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:

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

About Yourself:
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:
(with family or friends, outside, in my car, motel/hotel)
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?
Family Information:
(including area code)
(including area code)
Emergency Contact Information:
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?
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:
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.