RISE RIDES

Name *

First Name

Last Name

Phone *

(###)

###

####

What is the best way for RISE to contact you? *

Phone call

Text message

Email

Who is the RISE/Defy participant loved-one you're wanting to visit through RISE Rides? *

First Name

Last Name

Are they a:

Previous Defy Graduate (before we changed our name to RISE in 2019)

Previous RISE Graduate

Current RISE Participant

Not quite sure (it's ok! we'll look it up!)

If approved, which pick up location will you need? *

Omaha location (TBD) Departing around 11:15am

Lincoln location (TBD) Departing around 12:30pm

Confirmation Date Verification of DOC (Mandatory) *

This confirmation will have come to you in an email from the Department of Corrections. Please submit the date your confirmation was sent. You will be asked later to send your confirmation.

MM

DD

YYYY

I understand this RISE Rides transportation services is for the 1:00PM visit on May 4, 2024 at NSP. *

Yes, I understand.

I understand RISE Rides are reserved on a first come, first serve basis following the submission of this form and approval from RISE staff. *

Yes, I understand.