INTAKE FORM

If you’re connecting to a navigator directly through The BRIDGE website, then you’re not currently involved with any of our partner organizations. You may be eligible to receive navigation if:

  • you’re a resident of Douglas County
  • you’re pregnant or a caregiver for a child younger than age 19
  • you don’t have an open CPS case

After you submit the form, a BRIDGE navigator will reach out to families via phone or text to schedule an appointment for a needs assessment.

Due to the holidays, referrals received after Wednesday, Dec. 18th will receive a response the week of Jan. 6, 2025.

Thank you for your patience.

Connect to Navigator

A little about you and your family

Full Legal Name(Required)
MM slash DD slash YYYY
How many children live in the household?
List the birthday for each child, under age 19, living in your home.
List the birthday for each child, under age 19, living in your home.
List the birthday for each child, under age 19, living in your home.
List the birthday for each child, under age 19, living in your home.
List the birthday for each child, under age 19, living in your home.
List the birthday for each child, under age 19, living in your home.
If there are more than seven children under age 19 living in your home, list them at the end of this form.
Address(Required)

What are some ways we can help you?

Need(Required)
What is your most urgent need? Check all that apply.
Usted necesita ser contactado por un Navegador que habla Español?

How did you find us?

What school district do your children attend?
Check all that apply.
What is the best time of day to contact you?
Check all that apply.
Consent
Can The BRIDGE add your information to the Find Help database?