Forms

BVCA Partnership operates over 30 programs. Each program has multiple services. Most programs and services are designed to interact with and complement each other. Thus you may qualify for, and want to use, more than one program. You will be required to fill out BVCA Partnership’s Family Intake Form, which can be obtained from one of BVCA’s Family Development Coordinators. To participate in several of BVCA’s programs, you must be income eligible. Download BVCA Partnership’s Brochure, English or Spanish version below.

Remember that programs change. New services are added, new counties are covered. Eligibility requirements change as new income guidelines are issued. Should this or other circumstances inhibit your enrollment in any BVCA program, you may appeal by downloading our Denial or Termination Appeal Form below. If you or a family member need assistance, please contact BVCA Partnership. We will be happy to discuss your particular situation and provide you with current information on all our programs and services. We will also refer you to other agencies whose services may benefit your family.

Basic Needs

BVCA Brochure

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BVCA Brochure – Folleto en espanol

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Customer Feedback Survey

Customer Feedback Survey

Denial or Termination Appeal Form

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Education

Head Start Application 0-5

Head Start Application 0-5

BVCA Head Start 0-5 Parent Handbook

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Family Development

Health & Nutrition

Immunization Program Authorized Information Release Form

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Housing

Homeownership Opportunity Program

Homeownership Opportunity Program

Housing Counseling

Housing Counseling

Owner-Occupied Housing Rehab

Owner-Occupied Housing Rehab

Rental Work Order Request Form

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Weatherization Assistance Program

Weatherization Assistance Program

Transportation

Volunteer Opportunities

Volunteer Application

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Denial or Termination Appeal Form

In the event that an individual feels they have been unfairly treated or discriminated against during the process of application or at any other time during program participation, they may appeal the decision to the staff member issuing the denial or termination for their consideration. If this does not change the termination or denial, the individual may file a formal appeal in writing to:

Blue Valley Community Action Partnership
P.O. Box 273
Fairbury, Nebraska
68352
changinglives@bvca.net

Mail within ten (10) business days of the denial or termination. Blue Valley Community Action Partnership will then act to support or overturn the action within thirty (30) business days of the receipt of the appeal. Should the appealing individual be dissatisfied with the result of the formal appeal, they may appeal to the BVCA Board of Directors’ Program Committee as a final appeal. The individual should include a letter to Blue Valley Community Action Partnership’s CEO requesting such an appeal. The CEO will schedule an appeal before the committee at Blue Valley Community Action Partnership’s next Board of Directors Meeting.

The appeal should indicate all information requested below on this form and should include any additional information or explanation of their situation:

Signature: 
Date:   
Address: 
Phone Number:   
Email:   
Date of Denial/Termination:   
Service Denied or Terminated: 

Feel free to use this space for additional information or explanation. Additional documentation may also be attached.

The Community Action Promise

Community Action changes people’s lives, embodies the spirit of hope, improves communities, and makes America a better place to live. We care about the entire community and we are dedicated to helping people help themselves and each other.

Volunteer Opportunities

Proudly Serving 9 Counties in Nebraska.

Select your county to see what services are available in your area.

We Also Offer Select Services in 15 Additional Counties in Nebraska and Iowa.

Select your county to see what services are available in your area.