Welfare Due Process Project

Online Intake Form

Welcome to Nebraska Appleseed’s on-line intake form. Nebraska Appleseed can provide referrals to help you with your problems and, if your case meets our specific criteria, we may work with you directly. In order to help you, we need to get some basic information. Please fill out the form below.

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Contact

Kate Bolz
Community Educator
Jennifer Carter
Staff Attorney
Erin Ching
Staff Attorney
Rebecca Gonzales
Program Assistant
Gloria Sarmiento
Program Associate

Full Name:
Contact Phone that you would like Nebraska Appleseed to use to get in touch with you:
Email Address:
Which of the following issues do you have concerns about right now?	Public Benefits (ADC, Food Stamps, etc.) Child Welfare Immigration Other (Criminal, Housing, etc.)
Please list the full name of anyone else involved in your case (for example, your spouse or child):