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. Our response time is typically the same day or the next business day after the form is received.

Connect to Navigator

Full Legal Name(Required)
MM slash DD slash YYYY
How many children live in the household?
What are the ages of each child?
Address(Required)
Need(Required)
What is your most urgent need? Check all that apply:
Usted necesita ser contactado por un Navegador que habla Español?