Growing Community Connections
Resource Directory
Growing Community Connections
Resource Directory

Application for Community Response

***Dakota/Dixon County, NE Residents Only.

Must have at least one dependent child age 17 or younger in the home.***

Please read the following as you have more steps to complete!! 

Services will not be able to start without completion of the next 2 steps!!

 

Please complete the form below.  Once completed, you will receive a confirmation email.

After the confirmation email, you will receive an email from Community Response via DocuSign. This email will arrive within 5-10 minutes after the confirmation email.

The detailed application via DocuSign must be completed before any services can start.

If you do not receive the email, make sure to check your spam/junk email folder.  If still not received, please email info@gcctristate.org

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Available Agencies

Please review the following questions carefully.  If you would prefer NOT to work with any Agencies or Service Providers please check the corresponding check box.  If you do not have a preference, you can skip these questions.

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Referral Info

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Release of Information

I hereby authorize the reciprocal release of information contained in these records between Dakota County Community Response and its partnering agencies. The purpose for such disclosure is assessment, services, and case management for connections to community resources. This consent allows my information to be shared between Dakota County Community Response and any partnering agencies within or outside of Dakota County Community Response that may assist with my case.

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