Application for Emergency Financial Assistance Email* Enter Email Confirm Email Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What Nebraska county do you live in?*Phone Number*Number of people in your household*Please list your financial obligations/needs (must be from April 1, 2020 or later) that you are requesting assistance with. Include the amounts due.*Financial ObligationAmount Due Enter one obligation per line. Use the "+" symbol to the right to add another line.What is your annual income?*Are you a legal resident of the United States or US Citizen?*ChooseYesNoAre you a resident of Nebraska?*ChooseYesNoHow have you been impacted by COVID?*How were you referred to this program?*Please email a picture of the following documents with your name to [email protected] Proof of Nebraska residency (drivers license or state ID, etc) Proof of citizenship or US residency (birth certificate, passport, green card, etc) 2 paystubs or bank statements demonstrating income A copy of bill(s) to be paid If you are unable to provide any of these documents, we will contact you to find alternative solutions.