Parent/Guardian
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Email Address (Required)
Confirm Email Address
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Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Languages
American Sign Language
Arabic
Caribbean Languages
Chinese
Dinka
East Asian Languages
English
European & Slavic Languages
Italian
Karen
Korean
Kurdish
Middle Eastern & So. Asian
Nat Cent Am, So Am & Mexican langs
Native N. Amer/Alaska Nat. Lngs.
Nuba
Nuer
Other - specify in comments
Pacific Island Languages
Russian
Sign
Spanish
Unspecified
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
No Schooling Completed
PHD
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Self-employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Adult who lives in the home and is related to the applicant (child or pregnant mom) by blood, marriage or adoption. Any other adults in the household can be added later.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Email Address
Confirm Email Address
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Languages
American Sign Language
Arabic
Caribbean Languages
Chinese
Dinka
East Asian Languages
English
European & Slavic Languages
Italian
Karen
Korean
Kurdish
Middle Eastern & So. Asian
Nat Cent Am, So Am & Mexican langs
Native N. Amer/Alaska Nat. Lngs.
Nuba
Nuer
Other - specify in comments
Pacific Island Languages
Russian
Sign
Spanish
Unspecified
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
No Schooling Completed
PHD
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Self-employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Family Information
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
African Languages
American Sign Language
Arabic
Caribbean Languages
Chinese
Dinka
East Asian Languages
English
European & Slavic Languages
Italian
Karen
Korean
Kurdish
Middle Eastern & So. Asian
Nat Cent Am, So Am & Mexican langs
Native N. Amer/Alaska Nat. Lngs.
Nuba
Nuer
Other - specify in comments
Pacific Island Languages
Russian
Sign
Spanish
Unspecified
Vietnamese
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Languages
American Sign Language
Arabic
Caribbean Languages
Chinese
Dinka
East Asian Languages
English
European & Slavic Languages
Italian
Karen
Korean
Kurdish
Middle Eastern & So. Asian
Nat Cent Am, So Am & Mexican langs
Native N. Amer/Alaska Nat. Lngs.
Nuba
Nuer
Other - specify in comments
Pacific Island Languages
Russian
Sign
Spanish
Unspecified
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Doctor/Medical Home
23rd Family Med LLC
Advanced Medical Imaging
Algeent Creighton Health
Alivation Health
Allergy, Asthma and Immunology
Anderson, Derrick Dr
Antelope Creek Family Physicians
Applegate, M. Scott Dr
Arispe, Emilio MD
Arkfeld, Dean, Dr
Ashland Clinic
Autumn Ridge Family Medicine
Avera Medical (Spencer, IA)
Banks, Dr
Bargen, Amy Dr
Basler, Rodney Dr
Bassett, Craig Dr
Baugous, Nancy Dr
Beatrice Medical Center
Bellevue Medical Center
Bernard, Robin Dr
Bernhardson, Paul Dr
Blake, Rachel Dr
Bleicher, Stacie Dr
Blomgren, James Dr
Bluestem Health
Bluestem Medical
Blumenstock Family Eyecare
Boelter, Carol Dr
Boone County Clinic
Bott, Matthew MD
Boys Town Hospital
Boys Town Pediatrics
Brabec, Bradford Dr
Brinkhoff, April Dr
Broadhead, Sarah MD
Bronson, Joann CNM
Bryan Medical Center
Bryan Primary Care
Bryan Women's Care
BryanLGH Medical Center
BryanLGH NICU
Butler, Mark Dr
Byington, Robert Dr.
Calderon, Cicero MD
Captial City Pediatrics
Carlson, Mark Dr
Carter, Kathy, Nurse Practitione
CCH Pediatric Clinic PC
Center for Maternal & Fetal Care
CHC Health Fam Yankee Hill
Cheney Ridge Family Medical Cent
CHI Family Medicine Clinic
CHI Health Birth Center
CHI Lakeside Dr Thomas Besse
CHI Women's Health (70th & A)
Children First
Children's Developmental Center
Children's Hospital - Omaha
Children's NE Specialty Pediatri
Children's Opthamology Clinic
Children's Physicians
Childrens Hospital - Lincoln
Christianson, Heather Dr
Christopher Youngman, MD
Chyday, Dr
Clinic With a Heart
Coady, William Dr
Coddington Medical
Coffey, Gina MD
Community Asthma Education Initi
Complete Children's Health
Creighton University Medical Cen
Crete Area Medical Center
Cruce, Alicia Dr
Davey, Kurt Dr
David, Jeffery Dr
Davis, Jason Dr
DeBoise, Douglas Dr
Deck, John Dr
Dell, Carrie, Dr
DeNell, Nathan DO
Desai, Alka MD
Dews, Heather Dr
DHHS
Doctors of Children
Doctors of Women
Doctors Outpatient Surgery Cente
DOCTORS Surgery Center
Douglas, Bernard MD
Downtown Physicians Group
Dr Craft
Dr Grosbach
Dr Jenna VanPelt
Dr. Paul Wolfe
Dr. Phil Boucher
Dr. Shannon Heiss
Dresbach, Anthony Dr
Duensing, David Dr
Durbin, Jr, Roy Dr
Dziko, Svjetlana Dr
Ear Nose & Throat Specialties
Early Childhood Special Educatio
Early Development Network
East Lincoln Family Health
Ebers, Douglas Dr
Ellis, Michelle L. Dr
Ellison, Joseph MD
Engel, Joshua, O.D.
ENT Nebraska
ENT Specialists PC (Omaha)
ENT Specialties
Eunus, Shahab Dr
Evans, Erin Dr
Every Woman Matters
Express Care Family Medicine
eye care specialists
Eye Surgical Associates
Eyes on Lincoln
Fallbrook Family Health
Family Health & Wellness Center
Family Health Associates, LLC
Family Health Care Center
Family Health Physicians
Family Health Services
Family Medicine of Lincoln
Family Medicine of Lincoln-PineL
Family Orthotics & Prosthetics
Family Physicians Group, PC
Family Practice Physicians-Bryan
Family Practice Specialists LLC
Ferris, Michael Dr
Fiala, Jenna Dr
Fischer, Timothy Dr
Fitzgerald, Amanda Dr
Foley, Katherine, Dr
Fraser, Jeffrey Dr
Fremont Health-Women's Care
Fremont Area Medical Center
Fremont Pediatric Partners
Friesen, Corwin Dr
Friesen, Kurstin Dr
Frontera, Laura Dr
Frontier Pediatric Care
George Wolcott, MD
Germer, Michael Dr
Gfeller, Bruce Dr
Gibbens, Donald Dr
Glenn, Matthew Dr
Good Life Birth Place
Good Neighbor Center -Fremont
Grady, Sara PA
Grandgennet, John
Gray, Caron Dr
Greisen, Joel Dr
Gretna Children's Physicians
Gretna Family Clinic
Groppe-Glesselman, Paige Dr
Gupta, Kirtibala Dr.
Gynecology & Fertility PC
Hamann, Julie Dr
Hammett, Patricia MD
Handke, Lane, Dr
Handprints and Footsteps PC
Hansen, George Dr
Harper, James Dr
Harrison, Francis Dr
Hart & Arndt Family Health, PC
Hart and Arndt Family Health, PC
Hart, LaDonna APRN
Hattan, Gregory Dr
Hauswald, Tyler PA
Hayes, Kristy Dr
Hayes, Paul Dr
Health & Wellness Center
Health 360 Integrated Care
Health Department
Heartland Family First Medical
Heartland Optical
Heartland Speech & Language
Hearts and Hands Woman Care
Herd, Richard Dr
Hier-Duffin, Shari Dr
Hodge, Dennis Dr
Holmes Lake Family Medical
Holy Family Medical Associates
Homan, Thomas, PA
Houston, Stacey Dr
Huff, Harold Dr
Husain, Rubab Dr
Hustad, Gary Dr
Imig, Carmella Dr.
Indian Hills Physicians Clinic
Integrated Women's Health
Jacobsen, Dorthea, Dr
Jacobsen, Matthew Dr
Jensen, Jennifer Dr
Jessie Coffey
Jirovec, Richard Dr.
Johnson, Eric Dr
Johnson, Susan Dr
Johnson, Todd Dr
Jones-Jobst, Sian Dr
Jordan, Travis Dr
Katie Vollmuth
Kaufman, David
Keim, Christine Dr
Kenney, Sean Dr
Kester, Amanda Dr
Kid Care
Kiechel, Frederic Dr
Kinberg, Jo Dr
Koch, Robert Dr
Kohl, Sean Dr
Krause, Cassie
Kreshel, Charles Dr
Kumph, Rex DDS
Lange, John Dr
Larson, Elizabeth Dr
Law, Angela Dr
Lawton Community Health Center
Leaps & Bounds Pediatric Therapy
Lee, DDS
Lester, Karla Dr
Lifecare Family Medicine
Lin. Fam. Health Professionals
Lincoln Family Medical Center
Lincoln Family Medical Group
Lincoln Family Medical Group
Lincoln Family Medicine Center
Lincoln Family Practice
Lincoln Family Wellness PC
Lincoln Medical Education Partn
Lincoln OB/GYN
Lincoln Pediatric Group
Lincoln Surgical Center
Lincoln Vision Center
LLCHD Doctor
Loucks, Erin Dr
MacDonald, Madeleine Dr
Mahloch, Mark Dr
Majerus, John Dr
Maly, James Dr
Martin, Ameeta Dr
Martin, Todd Dr
Mathais, Monica Dr
Mathews, Nancy Dr
Matthias, Sarah Dr
McCann, Rachel MD
McCarthy, Stephanie Dr
McCook Clinic PC
McCoy, Michael Dr
McGivney-Liechi, Karen, CNM
McNeely, Philip Dr
McPherson, Scott Dr
Meduna, David Dr
Meduna, Leo Dr
Meier, Craig MD
Meier, MD
Methodist Physician'sClin-Elkorn
Methodist Physicians Clinic
Methodist Women's Hospital
Milius, Gary Dr
Milkworks
Miller, Tim APRN
Morin, Peter Dr
Mota, Mario Dr
Mueller, Royce Dr
Mullendore, Sean MD
Munroe Meyer Institute
Munroe-Meyer Institute
Myers, Michael Dr
Nebraska Comprehensive Health C
Nebraska Eye Institute
Nebraska Medical Center
Nebraska Surgery Center
Nebraska Urban Indian Medical Ct
Needelman, Dr
Nessetti, Doris Dr
Nessetti, Matthew Dr
Neuhaus, Stephanie MD
New Life Clinic
New Life Obstetrics & Gynecology
Niazi, Akhtar Dr
Nissen, Alan Dr
Nohner, Kevin Dr.
Nollendorfs, Alisa Dr
North Lincoln Family Medical Cen
NorthPointe Family Medicine
O'Grady, Patrick Dr.
Obergon, Heatlher MD
Ogren, Frederic Dr.
Olson, Cynthia Dr
Olson, Terry Dr
Omaha Children's Clinic
Omaha Ear Nose & Throat Clinic
Omaha OB/GYN Associates, PC
One World Community Health Cente
Out Of State Provider
Paradis, Mara Dr
Payless Optical Outlet
Pearle Vision Center
Pediatric Cardiology Affiliates
Pediatric Partners LIC
Pediatrics PC
People's City Mission
People's Health Center
Petersen, Michelle Dr
Peterson, Nancy CNM MSN
Phillips, Allison Dr
Physician's For Women
Pierce, Kelly Dr
Pierre, Yves-Lande Dr
Pine Lake Health
Pioneer Greens Dentistry
Pitner, Sheryl Dr
Plambeck, Robert Dr
Pope, Douglas Dr
Prairie Lake Family Medicine
Prescher, Scott Dr
Primary Care Physician
Public Health Nurse
Quinn, Joan Dr
Rapp, Michael Dr
Rasmussen, Chad Dr
Rector, Jerald, Dr
Red Cross
Reiser, Jennifer MD
Reynolds, Sonya Dr.
Richard Jirovec
Rida, Boshra Dr
Rizal, Dr MD
Rock, Eileen M.D.
Rohwer, David Dr
Runge, Kristin, PA-C
Russell, Stephen Dr
Rutz, David Dr
Saathoff, Steven Dr
Saint Elizabeth Regional Medical
Saqueton, Dr
Sarah Cada
Sauberan, Donald Dr
Saunders County Medical Center
Sayers, Michael Dr
Schaffer, Brad Dr
Schauer, Brad, PA
Schiffbauer, John Dr
Schmidt, Michael Dr
Schumacher, Jearlyn - CNM
Sellon, Janet Dr
Sellon, Monte Dr
Semm, H. Russell Dr
Shidler, Kelli Dr
Shopko Eyecare
South East Family Medicine
South Lincoln Dermatology
southeast family medical
southpointe family physicians
Southwest Family Health
Southwest Family Medical
Sprague, Charles Dr
Springman, Sue Dr
St Luke's Hospital
St. Elizabeth Hosp
Staack, Dr
Stauffer, Jenda CNM
Steckelberg, James Dr
Stephenson, Betsy Dr
Stevens Creek Family Medicine
Stevens, Christine Dr
Strohmyer, Jeffrey Dr
Sunny Meadow Medical Clinic
Superior Family Medical
Swanson, Stephen Dr
Swisher, William Dr
Tan, Rosemarie, Dr
Taylor, Bruce Dr
Tegt, Thomas Dr
Tesmer, Timothy Dr
The Physician's Network (CHI)
The Wellness Place-Dr. Imig
Thoendel, Victor Dr
Thompson Clinic
Three Rivers District Health Dep
Tomjack, Jeffrey Dr
Troia Dr. (Omaha)
Tucker, Bette APRN
United Way of Lincoln and Lan
Unity Point
University Health Center
UNL Barkley Memorial Center
UNMC Physicians
Urban Indian Medicine Center
Vandenhul, Suzanne Dr
Vander Pol, Sarah Dr
Vanderbur, Lars Dr
Village Pointe Pediatrics
Votruba, Amanda MD
Wahoo Family & Sports Medicine
Wahoo Vision Center
Walburn, John Dr
Walmart Vision Center
Walsh, Michelle Dr
Webb, Brandon Dr
Weeks, William Dr
Weiss, Marlon Dr
Wellness Place (The)
Wergin, Robert Dr
West Lincoln Family Medicine
West, Pamela S, MD
Westburg, Stuart Dr
Whaley, Debra Dr
Whitcomb, Lisa Dr
WIC
WIC Food & Nutrition Program
Willman, Brent Dr
Wilson, Scott Dr
Wolfe, Dana Dr
Wolfe, Janet Dr
Women's Care Physicians
Women's Clinic Of Lincoln
Women's Health Care Williamsburg
Women's Health-Health Care for W
Woodford, Robert D
Wooldridge, Terry Dr
Wurtz, Richard Dr
Yaghmour, Anthony Dr
York Medical Clinic
Dentist/Dental Home
3D Dental
Adams Dental Center
Admire Dental
Aiello, Anne DDS
Alderman, Brad DDS
Alderman, Kathryn DDS
Amberly Dental
Ameku, Yosh DDS
Amend, Cori DDS
Antelope Creek Family Dentristry
Antholz, Travis DDS
Aspen Dental
Avera Medical (Spencer, IA)
Batko,
Baum, Douglas DDS
Beck, Alan DDS
Bellevue Pediatric Dentistry
Bennett, Jane DDS
Benson Family Dentistry
Biehl, Elizabeth DDS
Blankenau, Thomas DDS
Blome Family Dentistry
Bluestem -Dental Clin
Bowles, Meagan DDS
Branchaud, Jay DDS
Bright Smile Dental Inc
Brunmeier Richard DDS
Bundy Family Dentistry
Burbach, Michael DDS
Burgher, Luke DDS
Canyon Echo Dental LLC
Capital Dental
Chadwell, Amy DDS
Charles F Craft DDS
Children's Dental Clinic
Children's Dental Specialists
Children's Dentistry of Lincoln
Choobineh, Maryam DDS
Christensen, Susan DDS
Clinic With a Heart
Coddington Dental
Coke, Richard DDS
College View Dental
Collegeview Dental
Complete Family Dentistry
Cooper, Jack DDS
David C Zieg
Dentist PC
Desai, Alka MD
Dinkelman, Timothy DDS
Dodson, Kent DDS
Donner, Sarah DDS
Dr Charles Genrich
Dr Maas DDS
Dr Scott Wieting
Dr. Biehl
Dr. Ciobanu DDS
Dr. Daniel Flynn
Dr. Gregory Weeder
Dr. Heidi Stark
Drahota, L James DDS
Fahey, Walter DDS
Family 1st Dental
FLOSS Family Dental & Surgical C
Fought, Greg DDS
Free, James DDS
Fremont Children's Dentistry
Fremont Children's Dentistry
Fremont Family Dentistry
Fricke, Donald DDS
Garcia, Tracy DDS
Gentle Dental
Gessford, Ben DDS
Glock, Jason DDS
Good Life Smiles
Good Neighbor Center -Fremont
Gouldie, Judd DDS
Gregory E. Utecht DDS
Gum, Tomika, DDS
Gutz, Dennis DDS
Haag, Claire DDS
Haag, E. Chris DDS
Hamilton, Scott DDS
Hart, Thomas DDS
Havelock Dental Group
Health Department Dental
Hedlund, Louis DDS
Hinrichs, Gregory DDS
Hodges, Eric DDS
Hohenstein, Bryan DDS
Hull, David DDS
Hunzeker, Cade DDS
Integrity Family Dentistry
Irish Taylor Dental, LLC
Johndreau, Melissa DDS
Johnson, Brent DDS
Johnson, Daniel DDS
Johnson, Elizabeth A. DDS
Johnson, Libby DDS
Johnson, Mark DDS
Justin Villafane
Kiefer, Thomas DDS
Killeen, Martin DDS
Killeen, Marty, DDS
King, Dennis DDS
Kobza, Travis DDS
Kohler, Kristin DDS
Kontras, James DDS
Korte, Allen DDS
Kotil, Darin DDS
Kumph, Rex DDS
Lacey, Stuart DDS
Lee, DDS
Lewis Family Dental
Lewis, Rusty DDS
Liebentritt, Matthew DDS
Lincoln Children's Dentistry
Lincoln Family Medical Group
Lincoln Medical Education Partn
Lincoln Pediatric Dentistry
Lincolnshire Pediatric Dentistry
LLCHD Dentist
Lovelace, Kent DDS
LPS Dental
Mancuso, DDS
Mapleview Dentistry
Maranatha Dental Group
Markin, Douglas DDS
Martin Lacey Antholz
Martin, Dennis DDS
Martin, Dennis DDS
Martin, Max DDS
Martin, Samuel DDS
Maurstad, Steven DDS
May, Gary DDS
McClellan, Chad DDS
Meakin, Glory DDS
Meske, Jessica, DDS
Meyer, Michael DDS
Milius, Tom DDS
Miller, Jay DDS
Morning Glory Dental
Newman Grove Family Dentistry
Nguyen, Van DDS
Nicholas Woodward, DDS
Northridge Dental
Northstar Dental
One World Community Health Cente
Optimal Dental, PC
Osenbaugh, Mary DDS
Palmer, James DDS
Papillion Pediatric Dentists
Parker, Richard DDS
Parks, Wesley DDS
Pediatric Dental Arts of Lincol
Pediatric Dental Associates
Pediatric Dentistry
People's Health Center Dentist
Pine Lake Dental Group
Pine Ridge Dental PC
Plooster, Roger DDS
Rainbow Dental
Rakes, George DDS
Reichenback, Richard DDS
Reichert Family Dental
Reiners, Kevin DDS
Rohrs, Jason DDS
Rothe, Vincent DDS
Schieber, Matthew, DDS
Scott (Fricke) Rebecca DDS
Secola, Lourdes DDS
Sheldon, Norman DDS
Sheridan Square Dental Associate
Skyline Pediatric Dentistry
Small Smiles Dental Center
Small Smiles Dental Omaha
Smile Station
South Lincoln Family Dentistry
Southwest Pediatric Dentistry
Sowers, Rebecca DDS
Star City Dental
Stark, Heidi DDS
Steckelberg, Melanie DDS
Strunk, Lisa DDS
Sullivan Family Dental
Summit Dental
Summit Dental Oakview
Sveen, Melissa DDS
Swanson, Larry DDS
Tarnjit, Saini DDS
Taylor, Brett
Taylor, Mark H. DDS
Tetrick, Thomas DDS
Tipp, Steven DDS
Tolly & Tolly Dentristry
Tolly, Chad DDS
Tolly, Harry DDS
Treat, Vicki DDS
Troia, Anthony DDS
Truong, Thu T DDS
Tullis & Tullis Dental Office
Tullis, Stephen DDS
University Plaza Dental
UNL College of Dentistry
UNMC College of Dentistry
UNMC Lincoln Dental
Utecht, Gregory DDS
Vacek, Timothy DDS
Vanicek, Mark DDS
Wahoo Family Dentistry
Webber, Barry DDS
Weber, Steven DDS
Weeder Pediatric Dentistry
Weeder, DDS
Wessling, Brian DDS
West Gate Dental
Wheeler, Terri DDS
Wilderness Station Ped Dentistry
Williamsburg Village Dental
Woodward, Nicholas, DDS
Wortman, Paul DDS
Does your child have a disability or do you have any concerns about your child's development?
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No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Head Start 2024-2025
3 to 5 year olds
Early Head Start 2024-2025
0 to 3 year olds and pregnancy
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Additional Applicant
Do you want to apply now for another child in your family?
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Siblings
Are there other children in the family?
Add a Sibling
After submission of the application please contact us to finish the application, sign, and provide copies of proof of your child's age, SNAP ebt card/ADC letter/12 months of income. Documents can be uploaded by you now if you have access, otherwise we will collect hard copies at your appointment. Contact us at jmaybee@communityactionatwork.org or #402-875-9328.
Required information is missing, see above.