Step-Up Omaha Registration

This information is confidential and kept on a secure server.

Name *

First

Last

Phone *

Date of Birth *//

Email *

Are you? *

Enrolled in Grade or Middle School
Enrolled in High School
Not Enrolled or Graduated/G.E.D.

Parent or Guardian Name *

First

Last

Parent or Guardian Email *

Which session time would you prefer for your sessions for 9 week program? (we cannot guarantee a time but will take this into consideration) *

Income Verification (Free/Reduced Lunch Letter, Section 8 Letter, 2 recent paystubs, etc) *

Click or drag a file to this area to upload.

Social Security Card *

Click or drag a file to this area to upload.

Photo ID: School and State *

Click or drag a file to this area to upload.

Birth Certificate or Age Verification Document from School *

Click or drag a file to this area to upload.

Media Release (under 19)

Click or drag a file to this area to upload.

WIOA-Youth Document

Click or drag a file to this area to upload.

Age: *

Attestation Form *

Click or drag a file to this area to upload.

Photo Release Form *

Click or drag a file to this area to upload.

Direct Deposit Form *

Click or drag a file to this area to upload.

Authorization and Consent to Release Information *

Click or drag a file to this area to upload.

By submitting this form, I agree to make my financial records available to the City of Omaha, its designee, or HUD for verification of above information. I certify that the information above is, to the best of my knowledge and belief, a true, correct and complete statement of my financial conditions as of the date stated herein. I am aware that Section 1001 of Title18 of the U.S. Code makes it a criminal offense to make false statements or misrepresentation to any Department or Agency of the U.S. as to matters within its jurisdiction.

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