YESS: Apply Online

lincoln.ne.gov

You must complete all fields marked with a *

Identification First Name* Middle Initial Last Name*

Date of Birth*

Contact Information Address*      Apt

City*      State*      Zip*

Email Address

Home Phone      Cell Phone

How did you hear about us?

Educational Information Select your current educational status:
Attending High School
Dropped out of High School
High School Graduate / GED
Attending Post High School

If attending school, name of school:

Financial Information Number of People in your Household*

Select your household income range for the previous 6 months*:

Check all that apply:*
ADC/TANF
Food Stamps (currently or within the last 6 months)
Currently in Foster Care or a Ward of the State or Tribe
County General Assistance
Refugee Cash Assistance
Supplemental Security Income
I do not receive any Public Assistance

About You Do you need assistance to complete school, training, college or finding and keeping a job?
Yes No

Check all that describe your situation*:
High School Dropout
Pregnant
Parenting
Homeless
Runaway (under 18 yrs old)
Foster Child / Ward of the State or Tribe
Offender (any court involvement)
Documented Disability
Native American
None of the above

Your Plans for the Future

Finish High School
Get my GED
Go to college, to study:
Get a job or find a better job
Other, please explain:

	YESS - Youth Education and Support Services is a program of the Workforce Investment Act Division of the Urban Development Department
	Urban Development \| Workforce Investment Program Division