Nebraska Youth Screen - Parent Version
For any juvenile cited by law enforcement, the Otoe County Attorney's Office would like certain information from such youth and his/her parent/guardian before proceeding with any criminal or juvenile court prosecution or diversion. You will be asked questions from the Nebraska Youth Screen (NYS) to aid in the processing of this matter. A separate survey link must be completed by your child. Please complete w/in 1 week of the date on the citation. If you are having difficulty with the survey please contact (402) 969-0319 or email
*Upon review you will receive a text or email confirmation regarding your child's program eligibility and next steps*
First & Last Name: *
First & Last Name of Child: *
Gender of Child: *
Race/Ethnicity of Child: *
Phone: *
Email: *
List the offense(s) your child was cited for: *
List any prior offenses and age at time of offense: (indicate "none" if no priors) *
List any prior diversion or probation services your child has received? (indicate "none" if your child has received no other services) *
What is your relationship to the child cited? *
How many live in the household? *
What discipline/consequences at home have already taken place due to this incident? *
Has he/she ever been suspended/expelled from school in the last 3 months? *
Has he/she skipped school in the last 3 months? *
Is he/she employed or involved in extra-curricular activities? *
Are you concerned with your son/daughter's friend choices? *
Was he/she intoxicated at the time of this offense? *
Has he/she tried/used cigarettes, chewing tobacco or nicotine vape products in the last 3 months? *
Has he/she consumed alcohol in the last 3 months? *
Has he/she used marijuana or THC products in the last 3 months? *
Have he/she ever been in a physical fight in the past 3 months? *
How often does your child get angry? *
Has your child completed any type of community service or volunteered in the past? *
Does your child receive any type of services in or outside the home: (counseling/therapy, tutoring, special education, etc.) Please list services he/she receives. *
Would you or your child like to receive additional services and/or information helpful to your family and what types if interested: (housing, food, school supplies, mentoring, counseling, etc.) *
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