Growing Community Connections (GCC) Support Services Intake Form

Our intake form helps us understand each family’s unique situation and identify the support services they are eligible for. By completing the form, families enable us to connect them with the most relevant resources, ensuring they receive the assistance and guidance that best meets their needs. Depending on eligibility, families may be asked to complete additional applications for specific programs to access all available support.

Eligibility Requirements:

Central Navigation:

• Dakota County Nebraska Resident

• Willingness to engage in the support and resources offered

  
  

Family Coaching:

• Dakota County Nebraska Resident​

• Must be a parent or a minor child aged eighteen or younger, or eighteen and high school, a non-custodial parent of a minor child or a pregnant parent in their household.

• Parent/Caregiver or child(ren) USA Citizen/Legal Resident

• Income at or below 200% of the Federal Poverty Level (FPL)

• Willingness to engage in the support and resources offered

  
  

Plans of Safe Care:

• Dakota County Nebraska Resident

• Families with children at risk due to parental substance use

• Willingness to engage in the support and resources offered

  
  

Connected Youth Initiative:

• Nebraska Resident​

• Be between the ages of 14 and 26

• Be living without family support

• Willingness to engage in the support and resources offered

Basic Information

Needs

Please answer a few questions about your family

*Note - Families income must be at or below 200% of the Federal Poverty Guidelines in order to qualify for Family Coaching.

Please click on the link to determine your families income meets the guidelines according to family size: Federal Poverty Guidelines

By typing your name, you certify all information is true and correct to the best of your knowledge.

Authorization to Share Your Information for Evaluation (Consent)

We would like to share some of your information with the Nebraska Children and Families Foundation Research and Evaluation team and their external partners. They aim to understand and improve how Growing Community Connections supports families. Your name, address, and other identifying information will NOT be shared. Only details about the services you received and their impact will be included. You may also be contacted for feedback about your experience.