Please complete the information below. All information submitted goes to a confidential database and will not be shared with anyone. We will contact you in the order that requests are received. It may take up to 7 business days during times of high volume. You will receive an email once you submit your request.

Please fill out the information below about the individual that you are contacting PTI Nebraska about. Thank you!

Professionals can use this section of the form to ask a Parent Outreach Coordinator for assistance or to refer a parent/family or individual to PTI Nebraska. If you choose for PTI Nebraska to contact the parent/family or individual directly, we will not be able to disclose any information without a signed release.