L.I.T.T. Youth Program Priority List

1
How did you hear about LITT?
I met Alexis in person at the JJC Back-to-school Bash
Social media (Instagram, Facebook, etc.)
A friend or family member told me
From my child's school
Website
Other
2
How many youth in your family are you interested in enrolling?* This field is required.
1
2
3
4
5
6
Other
3
Youth #1 First Name
4
Youth #1 Age
5
Youth #2 First Name
6
Youth #2 Age
7
Youth #3 First Name
8
Youth #3 Age
9
Youth #4 First Name
10
Youth #4 Age
11
Youth #5 First Name
12
Youth #5 Age
13
Youth #6 First Name
14
Youth #6 Age
15
School / district your children attends* This field is required.
Omaha Public Schools (OPS)
Westside Community Schools
Millard Public Schools
Elkhorn Public Schools
Ralston Public Schools
Papillion-La Vista Community Schools
Bellevue Public Schools
Gretna Public Schools
Fremont Public Schools
Blair Community Schools
Arlington Public Schools
Council Bluffs Community School District
Other
16
Zip code* This field is required.
17
Total Household size adults and children* This field is required.
18
Parent / Guardian Name* This field is required.
First Name
Last Name
19
Parent / Guardian Phone * This field is required.
Area Code
Phone Number
20
Parent / Guardian Email* This field is required.
example@example.com
21
What is your preferred contact method when registration opens?* This field is required.
Phone
Email
Either/Both
22
If your child could improve one thing about themselves this year, what would it be? (This can be anything — even something at home, not just school.)* This field is required.
23
What areas would you most like to see your teen grow or receive more support in this year?(select all that apply)* This field is required.
Motivation & Follow-Through (school and daily routines)
Peer Influence & Friend Choices (navigating school drama and setting peer boundaries)
Emotional Regulation & Coping (handling stress and healthy coping skills)
Confidence and Identity Struggles (building self-worth, positive self-talk)
Family Communication (reducing defiance or shutting down at home)
Focus & Goal-Setting
Direction & Future Planning
Organization
Other
24
Does your youth have sports or recreation schedules we should be aware of?* This field is required.
25
What day and time of week works best for your youth?* This field is required.
Weekend mornings
Weekend afternoons
Weekday after-school
Other
26
Thinking about all of the children you're enrolling, what would your family be comfortable contributing in total toward their participation in this program?
$0 — I would need full financial assistance
$1–$100
$101–$250
$251–$400
$401–$600
$601+ — I can cover most or all of the program cost
Other
27
Would you like to be considered for a scholarship or financial assistance seat?* This field is required.
Yes
No
Maybe
28
Race/ethnicity* This field is required.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Two or More Races
Prefer not to answer
Other
29
What is your household's approximate annual income?
Under $25,000
$25,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000–$149,999
$150,000 or more
Prefer not to answer
30
We have a few more programs in the works — want to be notified when any of these launch?* This field is required.
Summer Youth Programs/Camps
Future Youth Cohorts (beyond this one)
LITT Adult Program
Sobriety Coaching (for adults)
Not interested in additional programs right now
Other
31
Once you're done, let us know — we'd love to grab a quick photo with you and/or your youth! Who may we photograph today?By selecting an option below, you're giving permission for these photos/videos to be used in our marketing and promotional materials, sponsor and funder presentations, and future event materials.
My child/children
Myself
Both
I do not consent to photos/video today
32
Anything else you would like for us to know?
33
Once you hit submit, you wll be placed on the list! We'll reach out and notify you as soon as registration opens for the LITT Community Cohort.
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