Nebraska Shared Parenting Foundation

Nebraska Shared Parenting Foundation

New Client Application
Limited Scope ClinicAttorney ReferralMediation ServicesFinancial ServicesUn-Bundled Package
Today's Date

MonthDayYear
Date
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Case Number, if applicable relating to current legal issue
Nebraska County where your case is located
Other Parent or Party Involved*

First NameMiddle NameLast Name
Address of Other Parent or Party

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
YesNo
YesNo
YesNo
DivorcePaternity (Custody) FilingChild Support ModificationCustody ModificationOther
Number of Children Involved
Please Provide the Following for Each Child: First & Last Name; Date of Birth
Please provide the Dates and Addresses where the child or children have lived the last 5 years.
Who does the child or children currently live with?
Your currently monthly income.
The other parent or party's estimated monthly income.
Please use this space to provide any specifics about your case and what you wish to accomplish.
Should be Empty: