Prevention Demonstration Project Eligibility Form

Name *

(first and last)

Phone Number

(xxx) xxx-xxxx

Email Address

What is the best way for us to contact you? *

Phone Call

Text Message

Date of Birth *

You must be between the ages of 16 and 21 to be eligible for this program. (m/d/yyyy)

Current Address *

You must be living in Lincoln, and not currently experiencing homelessness, to be eligible for this program.

County you currently live in *

Are you at risk of losing your housing? *

(eviction notice, late payments, warnings from management, etc.)

Yes

If you have received an eviction notice or warning for your current residence, please email it to PDP@cedarskids.org.

Are you currently involved with the justice system? *

(probation, diversion, warrants, etc.)

Yes

Are you currently a ward of child welfare/in the foster care system? *

Yes

Are you currently employed? *

Yes

Are you currently in a housing program? *

You must not currently be in a housing program to be eligible for this program.

Yes

Do you receive non-cash benefits? *

(SNAP, WIC, TANF, etc.)

Yes

How can we best help you? *

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6601 Pioneers Boulevard, Suite 1

Lincoln, NE 68506

10840 Old Mill Road Suite 200

Omaha, NE 68154