To arrange a temporary contact, we ask that you be within 60 days of discharge from a treatment or correctional facility.

Please submit the online form below (preferred).

Or you may download/print a PDF Form and mail it to: Omaha Central Office, 6831 Grover St, Omaha, NE 68106

First Name / Last Initial(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
City/State/Zip(Required)
Where you will be residing after release.
Best number to reach you after release/discharge.
Preferred Contact(Required)
This field is for validation purposes and should be left unchanged.